STACK. Smoke-Free Environments

STACK.

Smoke-free Environments Act (Part II), 1990:

Student Smoking Status and Retailers

Perceptions

Ray Kirk Nicolette Edgar

O92O8

WA 754 KIR Health Research and Analytical Services - IQQ?. Ministry of Health STACK

- MOH Library I I1IlIMI ll I 99208M Copyright

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying or otherwise, without the prior written permission of the Ministry of Health.

Disclaimer

This report was prepared by Ray Kirk and Nicolette Edgar of Health Research and Analytical Services, Ministry of Health for the Public Health Services section of the Ministry of Health. Its purpose is to inform discussion and assist future policy development. Therefore, the opinions expressed in the report do not necessarily reflect the official views of the Ministry of Health.

This is an internal report not intended for wide distribution outside the Ministry of Health. As such it has not been reviewed outside the Ministry of Health.

Information Centre. Ministry of Health Wellington U Acknowledgements U U We would like to thank the students and retailers who participated in the surveys for their valuable replies. Also, we are grateful to the retailers who provided candid and constructive comments about the services and support they would like to receive from U the Ministry of Health. ci Bob Halliday undertook the detailed and extremely thorough statistical analyses of the student smoking survey. We are particularly grateful for his contribution to this report. U We are very grateful to Helen Leonard and Marie OConnell who entered the questionnaire responses onto a paradox database. U

Maureen Parkyn provided helpful secretarial and editorial assistance. ci

We appreciate the valuable assistance and support provided by the Health Research and Analytical staff, especially Penny Brander. ci U U ci ci U ci ci U U ci 11 ci Table of Contents

Chapter 1 Introduction ...... 1 1.1 Introduction ...... 1 1.2 What this report covers...... 4 1.3 Aims and purposes of the research...... 4

Chapter 2 Review of Literature on Adolescent ...... 5 2.1 Introduction ...... 5 2.2 Aims of the literature review ...... 6 2.3 Literature review methods ...... 7 2.4 Health and tobacco use ...... 7 2.4.1 Health risks for tobacco users...... 7 2.4.2 Health risks, tobacco use, and gender/ethnicity...... 7 2.4.3 Health risks for the unborn child and the passive smoker ...... 8 2.4.4 Financial costs versus financial gains ...... 8 2.4.5 Conclusions...... 9 2.5 Smoking prevalence - International literature ...... 10 2.5.1 Smoking prevalence amongst U.S. adults...... 10 2.5.2 Trends in smoking prevalence amongst adolescents ...... 10 2.5.2.1 U.S...... 10 2.5.2.2 Australia...... 14 2.5.3 Gender differences in smoking trends ...... 15 2.5.3.1 U.S...... 15 2.5.3.2 Australia...... 16 2.5.3.3 Great Britain ...... 16 2.5.4 Ethnic differences in smoking trends ...... 16 2.5.4.1 U.S...... 16 2.5.4.2 Australia...... 17 2.5.5 Conclusions...... 20 2.6 Smoking prevalence - New Zealand...... 21 2.6.1 Historical Background...... 21 2.6.2 Smoking prevalence amongst New Zealand adults...... 21 2.6.2.1 In general...... 21 2.6.2.2 Gender differences ...... 22 26.23 Ethnic differences ...... 23 2.6.2.4 Demographic differences...... 24 2.6.3 Smoking prevalence amongst New Zealand adolescents ...... 25 2.6.4 Gender differences...... 28 2.6.5 Ethnic differences...... 28 2.6.6 Conclusions...... 32

ii 11

2.7 Why do young adults initiate and maintain smoking . behaviours) ...... 33 II 2.7.1 Correlates of adolescent smoking behaviour...... 33 II 2.7.1.1 Peer group smoking behaviour...... 33 2.7.1.2 Family smoking behaviour ...... 35 2.7.1.3 Knowledge and attitudes about smoking...... 37 2.7.1.4 Demographics ...... 39 H 2.7.1.5 School related factors...... 41 2.7.1.6 Personal factors...... 42 2.7.1.7 Advertising...... 45 II 2.7.1.8 Availability ...... 46 2.7.2 Conclusions...... 46 II 2.8 Smoking prevention - International and New Zealand...... 48 2.9 School based educational programmes ...... 49 II 2.9.1 Smoking prevention programmes - historical background ...... 49 2.9.2 Efficacy of school based smoking prevention programmes...... 50 2.9.3 Smoking cessation programmes - historical background...... 53 H 2.9.4 Efficacy of school based smoking cessation programmes...... 54 2.9.5 Suggestions for more effective school based educational strategies and policies ...... 55 II 2.9.6 Conclusions...... 59 2.10 Media campaigns...... 60 II 2.10.1 Are mass media interventions effective) ...... 60 2.10.2 Future media campaigns...... 62 2.10.3 Conclusions ...... 64 ii 2.11 Restricting access to tobacco ...... 65 2.11.1 How easily can minors obtain tobacco? ...... 66 II 2.11.1.1 Direct estimates ...... 66 2.11.1.2 Self-report estimates...... 67 II 2.11.2 Interventions to increase the effectiveness of legislation...... 68 2.11.3 Suggestions for ways to make future II legislation more effective...... 70 2.11.4 Conclusions ...... 71 2.12 Taxation of tobacco...... 72 11 2.12.1. The higher the taxation, the lower the tobacco consumption...... 72 2.12.2 Taxation as part of a multiple intervention strategy...... 73 2.12.3 Other taxation strategies ...... 73 2.12.4 Killing the golden goose) ...... 74 II 2.12.5 Conclusions ...... 74 II II

IV 11 2.13 Banning cigarette advertising . 75

2.13.1 Tobacco advertising - market share or total sales...... 76

2.13.1.1 Evidence to support the total sales argument ...... 76 2.13.1.2 Evidence to support the market share argument...... 77

2.13.2 Adolescents - the market target? ...... 78 2.13.3 Females and Maori - market targets"...... 80 2.13.4 Conclusion - to ban or not to ban? ...... 81

2.13.4.1 Television/radio advertising...... 83 2.13.4.2 Written advertising ...... 83 2.13.4.3 Tobacco product packaging ...... 84 2.13.4.4 Tobacco company sponsorship...... 85 2.13.4.5 Other ...... 85

2.14 Limitations on where smoking is allowed...... 86 2.14.1 Conclusions ...... 86

2.15 Multiple level interventions ...... 87 2.15.1 Conclusions ...... 91

Chapter 3 Smoking survey of 12-17 year old school...... 93

3.1 Introduction ...... 93 3.2 Aims...... 94 3.3 Methods...... 94

3.3.1 Ethnic representation in the sample ...... 94 3.3.2 Data Collection ...... 94 3.3.3 Response Rate...... 95

3.4 Results ...... 96

3.4.1 Description of the sample...... 96 3.4.2 Smoking history of the student survey sample...... 98 3.4.3 Current smoking status of the survey sample ...... ill 3.4.4 In depth analysis of the Hawkes Bay student sample...... 119 3.4.5 Source and availability of cigarettes ...... 136 3.4.6 Brand awareness of the sample ...... 139 3.4.7 Cigarette brand preference of the sample ...... 143 3.4.8 Reason for brand preference ...... 147 3.4.9 Cigarette brand sponsorship of sporting activities/events...... 149 3.4.10 Sports recalled as being "Smoke-free" sponsored ...... 158 3.4.11 Non-sporting events recalled to be smoke-free sponsored.....159 3.4.12 Cigarette company sponsorship of non-sporting events...... 160 3.4.13 Correlational analysis of brand awareness, brand preference and brand association with sport ...... 161

v 3.5 Summary . 162 3.5.1 Age 162 3.5.2 Gender...... 162 3.5.3 Ethnicity...... 163 3.5.4 Area...... 163 3.5.5 Source of cigarettes...... 163 3.5.6 Brand awareness ...... 163 3.5.7 Brand preference...... 164 3.5.8 Reason for the brand preference ...... 164 3.5.9 Brand association ...... 164

Chapter 4 Survey of retailer information and support needs regarding the Smoke-free Environments Act (1990)...... 165 4.1 Introduction ...... 165 4.2 Aim...... 166 4.3 Methods ...... 166 4.3.1 Response Rate...... 167 4.4 Results ...... 168 4.4.1 Description of the sample...... 168 4.4.2. Retailer Smoke-free legislation information sources andcontent...... 169 4.4.3. Retailer understanding of the Smoke-free legislation...... 176 4.4.4. Retailer Smoke-free legislation information needs...... 180 4.4.5. Support and assistance provided to retailers regarding the Smoke- free legislation ...... 183 4.4.6. Sale of cigarettes to individuals under 16 years of age...... 189 4.4.7. Support and assistance needs of retailers ...... 200 4.4.8. Information needs of retailers...... 205 4.4.9. Retailer perceptions of the requirements of the Smoke-free legislation...... 207 4.4.10. Retail outlet display of signs or posters depicting tobacco sponsored events ...... 221 4.4.11. Cigarette products sold by retailers ...... 222 4.4.12. Retailer general comments about the Smoke-free legislation ...... 222 4.5. Summary ...... 224

Chapter 5 Summary and Conclusions ...... 229 5.1 Literature Review ...... 229 5.2 Student smoking survey ...... 234 5.3 Retailer survey...... 238

vi References .246

Appendices...... 265

Appendix 1 The student smoking survey

Appendix 2 Additional demographic information about the sample Appendix 3 Retailer information and support needs survey Appendix 4 The retailer survey cross-tabulation tables

Appendix 5 Retailer comments about the Smoke-free legislation

Appendix 6 Smoke-free sponsorships undertaken by the Health Sponsorship Council (1991/92)

VII List of Tables

Table 2.1 Smoking prevalence - U.S. adults 11 Table 2.2 How often do U.S. adolescents smoke? ...... 12 Table 2.3 How much do U.S. adolescents smoke? ...... 13 Table 2.4 Ethnic differences in smoker status in the U.S...... 18 Table 2.5 Ethnic differences in frequency of smoking behaviours amongst U.S. adolescents...... 19 Table 2.6 Smoking prevalence - New Zealand adolescents ...... 26 Table 2.7 Gender differences in smoking prevalence - New Zealand adolescents 29 Table 2.8 Ethnic differences in smoking status - New Zealand adolescents...... 30 Table 2.9 Ethnic differences in adolescent smoking behaviour - N.R.B. studies...... 31 Table 2.10 Number of cigarettes smoked by ethnicity - New Zealand...... 31 Table 3.1. Smoking survey and response distribution across highschools...... 95 Table 3.2 Gender description of the sample...... 96 Table 3.3 Age description of the sample ...... 96 Table 3.4 Ethnicity of the student sample ...... 97 Table 3.5 Place of residence of the student sample ...... 98 Table 3.6 Question I Have you ever smoked a cigarette?" [smoking history] ...... 98 Table 3.7 Smoking history by Gender ...... 99 Table 3.8 Smoking history by Gender - [for those who have triedsmoking] ...... 99 Table 3.9 Smoking history by Age (years) ...... 99 • Table-3. 10 Smoking history by Age: [for those that have triedsmoking] ...... ioo Table 3.11 Smoking history by Age: Females...... 100 Table 3.12 Smoking history by Age [for those who have tried smoking once]: Females...... 101

vii n Table 3.13 Smoking history by Age: Males . 101 Table 3.14 Smoking history by Age [for those who have tried smoking]: Males...... 102 Table 3.15 Smoking history by Ethnic group...... 102 Table 3.16 Smoking history by Area...... 103 Table 3.17 Smoking history by Gender: Age 12-13 ...... 103 Table 3.18 Smoking history by Gender: Age 14-15 ...... 104 Table 3.19 Smoking history by Gender: Age 16-17 ...... 104 Table 3.20 Smoking history by Gender: Maori...... 105 Table 3.21 Smoking history by Gender: Non-Maori ...... 105 Table 3.22 Smoking history by Age: Females...... 106 Table 3.23 Smoking history by Age: Males...... 106 Table 3.24 Smoking history by Age: Maori ...... 107 Table 3.25 Smoking history by Age: Non-Maori ...... 107 Table 3.26 Smoking history by Ethnic group: Females ...... 108 Table 3.27 Smoking history by Ethnic group: Males ...... 108 Table 3.28 Smoking history by Area: Female ...... log Table 3.29 Smoking history by Area: Male...... 109 Table 3.30 Smoking history by Area: Maori...... 110 Table 3.31 Smoking history by Area: Non-Maori ...... 110 Table 3.32 Current smoking status by Gender...... 112 Table 3.33 Current smoking status by Gender [for those who have tried smoking]...... 112 Table 3.34 Current smoking status by Gender...... 112 Table 3.35 Current smoking status by Age...... 113 Table 3.36 Current smoking status by Age [for those who have tried smoking]...... 113 Table 3.37 Current smoking status by Ethnic group...... 114 Table 3.38 Current smoking status by Area ...... 114

Ix Table 3.39 Current smoking status by Age: Females ...... 114 Table 3.40 Current smoking status by Age: Males...... 115 Table 3.41 Current smoking status by Gender: Maori...... 115 Table 3.42 Current smoking status by Gender: Non-Maori ...... 115 Table 3.43 Current smoking status by Age: Maori ...... 116 Table 3.44 Current smoking status by Age: Non-Maori ...... 116 Table 3.45 Current smoking status by Ethnic group: Females ...... 116 Table 3.46 Current smoking status by Ethnic group: Males...... 117 Table 3.47 Current smoking status by Area: Female...... 117 Table 3.48 Current smoking status by Area: Male...... 117 Table 3.49 Current smoking status by Area: Maori...... 118 Table 3.50 Current smoking status by Area: Non-Maori ...... 118 Table 3.51 Smoking history by Area ...... jig Table 3.52 Smoking history by Area [for those who have triedsmoking] ...... 119 Table 3.53 Current smoking status by Area...... 120 Table 3.54 Smoking history by Area: Females...... 120 Table 3.55 Smoking history by Area: Males...... 121 Table 3.56 Smoking history by [for those who had tried smoking]: Females ...... 121 Table 3.57 Smoking history by Area [for those who had tried smoking]: Males...... 121 Table 3.58 Current smoking status by Area: Females...... 122 Table 3.59 Current smoking status by Area: Males...... 122 Table 3.60 Smoking history by Area: Maon...... 123 Table 3.61 Smoking history by Area: Non-Maori ...... 123 Table 3.62 Smoking history by Area [for those who had tried smoking]: Maori...... 124

x 9 Table 3.63 Smoking history by Area [for those who had tried smoking]: Non-Maori...... 124 Table 3.64 Smoking history by Area: Female Maori...... 124

Table 3.65 Smoking history by Area: Female Non-Maori...... 125

Table 3.66 Smoking history by Area: Male Maori...... 125 Table 3.67 Smoking history by Area: Male Non-Maori ...... 126 Table 3.68 Smoking history by Area [for those who have tried smoking]: Female Maori ...... 126 Table 3.69 Smoking history by Area [for those who have tried smoking]: Female Non-Maori ...... 127 Table 3.70 Smoking history by Area for those who have triedsmoking ...... 127 Table 3.71 Smoking history by Area for those who have tried smoking ...... 127 Table 3.72 Current smoking status by Area: Maori ...... 128 Table 3.73 Current smoking status by Area: Non-Maori ...... 128 Table 3.74 Current smoking status by Area: Female Maori...... 129 Table 3.75 Current smoking status by Area: Female Non-Maori...... 129 Table 3.76 Current smoking status by Area: Male Maori...... 129 Table 3.77 Current smoking status by Area: Male Non-Maori ...... 130 Table 3.78 Smoking history by Ethnic group: Females in Hawkes Bay ...... 130 Table 3.79 Smoking history by Ethnic group: Males in Hawkes Bay...... 131 Table 3.80 Smoking history by Ethnic group: Females in the Otherareas ...... 131 Table 3.81 Smoking history by Ethnic group: Males in the Otherareas...... 131 Table 3.82 Smoking history by Ethnic group [excluding those who have never smoked]: Females in Hawkes Bay...... 132 Table 3.83 Smoking history by Ethnic group [excluding those who have never smoked]: Males in Hawkes Bay...... 132 Table 3.84 Smoking history by Ethnic group [excluding those who have never smoked]: Females in Other areas ...... 133

xi Table 3.85 Smoking history by Ethnic group [excluding those who have never smoked]: Males in the Other areas ...... 133

Table 3.86 Current smoking status by Ethnic group: Females in HawkesBay ...... 133

Table 3.87 Current smoking status by Ethnic group: Males in HawkesBay ...... 134

Table 3.88 Current smoking status by Ethnic group: Females in the Other areas ...... 134

Table 3.89 Current smoking status by Ethnic group: Males in the Other areas ...... 134

Table 3.90 Source of cigarettes ...... 136

Table 3.91 Source of cigarettes using combined categories...... 137

Table 3.92 Cigarette Source by Gender...... 138

Table 3.93 Source of Cigarettes by Age...... 138

Table 3.94 Source of Cigarettes by Ethnic Group...... 139

Table 3.95 Cigarette brand awareness ...... 140

Table 3.96 Cigarette brand sales 1991 and brand awareness ...... 141

Table 3.97 Brand Awareness by Gender...... 141

Table 3.98 Brand Awareness by Age ...... 142

Table 3.99 Brand Awareness by Ethnic group...... 142

Table 3.100 Brand Awareness by Area...... 143

Table 3.101 Cigarette brand preference ...... 144

Table 3.102 Brand Preference by Gender ...... 145

Table 3.103 Brand Preference by Age...... 145

Table 3.104 Brand Preference by Ethnic Group...... 146

Table 3.105 Brand Preference by Area ...... 146

Table 3.106 Reason for brand preference ...... 147

Table 3.107 Reason for Brand Preference by Gender ...... 147

Table 3.108 Reason for Brand Preference by Age ...... 148

Table 3.109 Reason for Brand Preference by Ethnic group...... 148

xl Table 1110 Reason for Brand Preference by Area • 148 Table 3.111 Brands associated with Rugby League...... 149 Table 3.112 Brands associated with Tennis ...... 149 Table 3.113 Brands associated with Softball...... 150 Table 3.114 Brands associated with Car Rallying...... 150

Table 3.115 Brands associated with Cycling...... 152 Table 3.116 Brands associated with Soccer ...... 152 Table 3.117 Brands associated with Motor car racing ...... 153 Table 3.118 Brands associated with Motor cycle racing ...... 153 Table 3.119 Brands associated with Harness racing ...... 154 Table 3.120 Brands associated with Gallops ...... 154 Table 3.121 Brands associated with Various Sports (Aggregate) ...... 155 Table 3.122 Brand Association with Sports by Gender...... 156 Table 3.123 Brand Association with Sports by Age ...... 156 Table 3.124 Brand Association with Sports by Ethnic Group ...... 157 Table 3.125 Brand Association with Sports by Area...... 157 Table 3.126 Sports recalled as being smoke-free sponsored...... 158 Table 3.127 Non-sporting events recalled to be smoke-free sponsored ...... 159 Table 3.128 Non-sporting events recalled to be cigarette company sponsored...... 160 Table 3.129 Pearson correlations between Brand Awareness, Brand Preference and Brand Association with Sport ...... 161 Table 4.1 Type of retail business ...... 168 Table 4.2 Length of time retailer at current address ...... 169 Table 4.3 Have you received any information about the Smoke-free legislation? ...... 170 Table 4.4 Source of the Smoke-free legislation information...... 172 Table 4.5 Content of the Smoke-free legislation information...... 175 Table 4.6 Retailer understanding of the requirements of the Smoke-free legislation ...... 176

XII II

Table 4.7 Retailer perception of their staffs understanding of the requirements of the Smoke-free legislation...... 178 II Table 4.8 Do you [the retailer] want more information on the requirements of the Smoke-free legislation from I the Department of Health? ...... 180 Table 4.9 If you [the retailer] want more information on the requirements II of the Smoke-free legislation from the Department of Health, what type of information would you prefer) ...... 182 Table 4.10 Retailer recall of support/assistance received from the 11 following organisations ...... 183 Table 4.11 Have you [retailer] received sticker indicating you cant II sell cigarettes or tobacco to persons under 16 yearsof age? ...... 189 A Table 4.12 Is it difficult for the retailer to tell if a customer is under 16 years of age) ...... 192 Table 4.13 Do you [retailer] think retailers sell cigarettes to II children under 16 years of age with notes or who have parents in a vehicle outside the shop? ...... 198 II Table 4.14 No new tobacco product advertisements may be put up in or outside shops ...... 207 II Table 4.15 Existing tobacco product signs with health warning messages can stay up to 1.1.95...... 208 Table 4.16 Tobacco product advertising signs without a health II warning must be removed ...... 210 Table 4.17 Tobacco products can be displayed in a shop as long 11 as they cannot be seen from outside the shop...... 214 Table 4.18 Tobacco product price displays inside a shop must I not exceed 297 mm x 630 mm (3 x A4 sheets) ...... 216 Table 4.19 Notices inside a shop can only show what tobacco products are for sale and their price...... 217 [II Table 4.20 The shop name cannot include a trademark of the company name of a tobacco product ...... 218 II Table 4.21 Retailers who put up new tobacco advertisements can be fined up to $10,000, if convicted.-.. --;.- .1 ...... I ... 219 U Table 4.22 Retail outlet display of signs or posters depicting tobacco sponsored events ...... 221 II Table 4.23 The type of cigarette products sold by the retailers inour sample ...... 222 [II II

xiv II List of Figures

Figure 3.1 Benson & Hedges Sports Sponsorship Poster . 151 Figure 4.1 Information received about the Smoke-free legislation ...... 171 Figure 4.2 Number of cited information sources...... 174 Figure 4.3 Number of smoke-free information issues ...... 177 Figure 4.4 Retailer understanding of the Smoke-free legislation ...... 179 Figure 4.5 Do you [retailer] want more information on the requirements of the Smoke-free legislation from the Department of Health) ...... 181 Figure 4.6 Retailer support and assistance from the Department of Health ...... 184 Figure 4.7 Retailer support and assistance from Tobacco Companies...... 185 Figure 4.8 Retailer support and assistance from the Retailers Association ...... 187 Figure 4.9 Retailer support and assistance from area health board staff...... 188 Figure 4.10 Have you [retailer] received a sticker stating that you cant sell cigarettes or tobacco to under 16s) ...... 191 Figure 4.11 Do retailers sell cigarettes to minors with notes or with parents waiting outside the shop? ...... 199 Figure 4.12 No new tobacco product advertisements to be put up...... 209 Figure 4.13 Existing tobacco product signage can stay up to 1.1.95...... 211 Figure 4.14 Tobacco product advertising signs without a health warning must be removed ...... 212 Figure 4.15 Tobacco products may be displayed in a shop so long as they cannot be seen from outside the shop ...... 215 Figure 4.16 Retailers who put up new tobacco advertisements can be fined up to$l0,000, if convicted...... 220 Figure 4.17 The number of different types of cigarette packets sold by retailers ...... 223

xv U Executive Summary El The Public and Personal Health section of the Department of Health commissioned Health Research and Analytical Services, Department of Health, to conduct research investigating Part II of the Smokefree Environments Act, 1990. The report is divided U into three distinct sections. Section one reviews the literature adolescent smoking behaviour and knowledge and U details the strategies that have been used to prevent adolescents from starting smoking or smoking cessation programmes directed at adolescent smokers. U Section two reports the findings of a smoking behaviour and knowledge survey conducted with 890 New Zealand adolescents between 12 and 17 years of age. The results update a similar national survey of New Zealand adolescents conducted by the National Research Bureau in 1991 (National Research Bureau, 1991). U Section three focuses on Part II of The Smoke Free Environments Act (1990). The findings of a national survey of 1017 retailers support, understanding, knowledge and U information requirements related to Part II of The Smoke Free Environments Act (1990) are reported. U Aims and purposes of the research

• Literature review U The alms of the literature review were with respect to the following five topics: U (i) To describe and review the smoking behaviours and habits of adolescents

(ii) To describe and review tobacco promotion and adolescent smoking U (iii) To review proven health promotion strategies U (iv) To examine contemporary adolescent lifestyles and their impact on smoking behaviours and habits within a sociological context U (v) To describe and review the sale of cigarettes to "minors" U • Student smoking Survey The overall aim of this survey was to provide updated information on the nature and U extent of smoking behaviour and beliefs in a sample of 12-17 year old New Zealand school children. The specific aims were: 9 • To determine the incidence ofpast and present smoking behaviour examined by age, gender, ethnicity and place of domicile. U • To examine the awareness of advertising and brand promotion of tobacco products and their association through sponsorship with sporting and non- sporting events in a random sample of 12-17 year old school children. U U xvi 0 • Amongst current smokers, to describe the number smoked per week, sources of cigarettes, and brand(s) smoked and why.

• Retailer survey

• To determine what additional information and support retailers need to comply with the Smoke-free Environments Act (1990), especially Part Ii of the Act.

Methods

• Literature review

The main sources of information included:

• an on-line computer search of databases for relevant books, articles, reports and newspaper clippings,

• published and unpublished reports and documents provided by key informants, and

• recent journals were scanned for relevant articles.

• Student smoking Survey

The student smoking survey was conducted with a randomly selected sample of secondary school pupils from 14 high schools in five areas. Seven of the schools were located in main urban centres, four in provincial centres and three in smaller semi rural towns. Sampling procedures were weighted to ensure that a high level of Maori and Pacific Island representation was sampled.

The survey was a self-administered questionnaire completed at school. Demographic information sought included: age, gender, ethnicity and place of residence.

The final sample size was 890 students ranging in age from 12 to 17 years. A high response rate of 89 percent was obtained, (890/995).

• Retailer survey

The yellow pages of 18 Telecom telephone directories were used to obtain the population of retailers sampled. The headings scanned were "dairies" and "Grocers and Supermarkets".

The final sample size used in the analysis was 1017, which represented a response rate of 39 percent. That is, approximately four in ten dairy, grocery, supermarket, etc. retailers listed in the yellow pages of the telephone books completed and returned the survey. This is lower than expected, although there was no follow-up of non - respondents.

xvii Results

• Literature review

Eighty-five percent of lung cancer deaths and 30% of all cancer deaths are attributable to smoking.

Maori men and women have one of the highest recorded incidences of lung cancer in the world.

The lung cancer rate in New Zealand women tripled between 1964 and 1986 and is still rising.

Smoking is a major public health problem in New Zealand. Prevalence

Overseas surveys have observed a significant decline in the smoking prevalence of adults, accompanied by a somewhat less striking and more recent decline in the smoking prevalence of adolescents.

Ethnic differences in smoking have also been identified in both the U.S. and Australia.

One in four adult New Zealanders in 1990 were smokers with an average consumption of 12 cigarettes a day.

In New Zealand, cigarette consumption has declined since 1983 but this decline has been more marked for men then for women.

For Maori women there has been no clear evidence that smoking rates are falling: 58.5% in 1981; 62.0% in 1989; 57.2% in 1990. Approximately 50 New Zealand children take up smoking every day.

A survey of 1600 New Zealand teenagers aged between 10-15 years in 1989 and 1991 showed 4% in 1989 (5% in 1989) teenagers were regular smokers, a further 25% said that they had experimented with cigarettes to some degree, most only trying them once.

Adolescent smoking uptake and maintenance has been associated with a number of factors which can be grouped under eight main headings: • Peer group smoking behaviour

U Family smoking behaviour

U Knowledge and attitudes about smoking

U Demographics

U School related factors

xviii Personal factors Advertising Availability

Smoking prevention

The central aim of public policy in the control of cigarette smoking should be to minimize the health damage of cigarette smoking, with a secondary aim being to minimize the economic dislocation resulting from the achievement of this health goal. Intervention strategies focus on either changing the individual or changing the environment in which the individual operates.

Restricting access to tobacco

One solution to the problem of adolescent smoking is to restrict childrens access to cigarettes thereby reducing consumption of the product and, ultimately, damage to health.

Banning cigarette advertising

The extent to which cigarette advertising contributes to increases in smoking has been hotly debated by public health professionals and the tobacco industry. Research suggests that there are significant relationships between measures of advertising and smoking.

Student smoking Survey

Seventy percent of both males and females in the sample had smoked at least one cigarette.

Of the 13 year olds, 46% of the females and 38% of the male had tried smoking. For both sexes 80% of 15, 16, and 17 year olds had tried smoking. Three times as many females in comparison with males continued to smoke after their first cigarette. In the 16-17 year age group, 39% of the females and 24% of the males had smoked "lots of times": Twenty-six percent of females in comparison with 11 % of males became "regular smokers".

Sixty-five percent of Maori females had tried smoking compared to 16% of Non- Maori females. Fifty-five percent of Maori females vs. 35% of Non-Maori females were current smokers. Forty percent of Maori females were "regular smokers" •compared- to only 15% of Non-Maori females.

Among Maori in our sample, four times as many females (40%) as males (10%) were "regular smokers".

xix Hawkes Bay had the highest percentage of subjects who had tried smoking at least once (77%), the highest percentage who had "Smoked lots of times (38%) and the highest percentage of current "regular smokers" (24%). The majority of subjects in our sample either purchased their cigarettes themselves or obtained them from friends.

Female students (54%) are more likely to purchase cigarettes from a shop in comparison with male students (40%). Maori students were more likely to purchase cigarettes from a shop (64%) and ask their parents for cigarettes (25%) in comparison to Non-Maori students (46%, 10%, respectively).

A third of 12-13 year olds and half the 14-15 year olds reported they purchased their cigarettes from a shop.

The most frequently recalled cigarette brand names were: Winfield (cited by 59% of the sample), Pall Mall (60%), Benson & Hedges (47%), Rothmans (43%), Holiday (32%), Peter Jackson (31%), John Brandon (23%), Camel (13%), Marlboro (11 %), and Dunhill (11%).

It is of significance that the major cigarette brand names recalled are those brands that sell and those associated with major tobacco sponsorships. Pall Mall (cited by 27% of smokers in the sample), Winfield (26%), Benson & Hedges (15%), Rothmans (13 %), Holiday (10%), John Brandon (9%), Peter Jackson(7%), Dunhill (4%) were the brands most "usually smoked" by our sample. It is of significance to note that the major cigarette brand names recalled by the 12-17 sample are also the main brands that sell and the main brands associated with major tobacco sponsorships.

Taste was identified as the main reason for brand preference by 55% of smokers in the sample followed by price (21%). Forty-four percent of the students who smoked had no brand preference.

Only three brands of cigarettes were significantly associated with sporting events. These were Winfield (cited by 50% of the sample), associated with rugby league, soccer and softball, Benson & Hedges (28%) associated with Tennis, and Rothmans (26%), associated with car rallying, motor cycle racing and car racing. Twenty-four percent of the sample knew that Benson & Hedges sponsored fashion awards.

Activities believed to be Smokefree sponsored were Netball (cited by 31% of the sample), Basketball (19%), and Rockquest (4%). There were highly significant correlations-- between Brand Awareness, Brand Preference and Brand Association with Sport.

xx Retailer survey Sixty-one percent of the respondents indicated that could recall receiving information regarding the requirements related to the Smokefree legislation. Over sixty percent of the respondents cited the Department of Health as the leading source of information about the Smokefree legislation. Nearly all retailers who received information recalled it involved the sale of cigarettes to under 16 year olds. Nearly two-thirds of respondents recalled receiving information about Smokefree workplace policies. Approximately half the retailers considered they understood the requirements of the Smokefree legislation and half thought they understood some of the requirements.

Three out of four "new" retailers wanted further information in comparison with half the "established" retailers.

Only a third of retailers indicated they had received support or assistance from the Department of Health and tobacco companies, respectively, in association with the S mokefree legislation. A high number of the respondents reported that they had received the sticker indicating they could not sell cigarettes or tobacco to under 16s. Three quarters of the retailers indicated is was difficult for them to tell if the customer was under 16 years of age.

Retailers indicated a number of options would make it easier for them to determine the age of customers, such as, the carrying of photo ID cards, and increasing the age of legal purchase of tobacco products to 18 years, although retailer views about this latter option were divided.

Retailers indicated they required further support and help in the following areas: more updated information about the Smokefree legislation, more display signs which are larger than presently used, multilingual sings, and further public education of the requirements of the Smokefree legislation. Retailers indicated that they would like further specific information on the Smokefree legislation, such as, legal information and notification of any changes in the Smokefree legislation.

Just over half the respondents agreed with the statement that no new tobacco product advertisements may be put up in or outside shops. Just over three quarters of the retailers agreed that tobacco advertising signs without a health warning must. be removed. Forty-five percent of respondents agreed with the statement that all tobacco product advertising signs must be removed after 1 January 1995. Just under half the retailers agreed with the statement that tobacco product price displays inside the retail outlet must not exceed the size of 3xA4 sheets.

xxi Just under half the retailers agreed with the statement that tobacco product price displays inside the retail outlet must not exceed the size of 3xA4 sheets. Only 38 percent of retailers agreed that they could be fined up to $10,000, if convicted, for putting up new tobacco advertisements. Only 15 percent of retailers indicated that they sold cigarettes singly. The vast majority of retailers sold cigarettes in packets, with the most frequently sold being: 20s (97 percent), 25s (96 percent), and lOs (91 percent). Cartons were sold by 72 percent of the respondents. Problems related to Part II of the Smokefree legislation include:

E The language of the Smokefree Environments Act, 1990 The "Grandfather Clause"

U Enforcement

The report will assist the Ministry of Health, Public Health Commission, Regional Health Authorities, Crown Health Enterprises and other provider groups, to further develop policy and health promotion and education practices to determine what additional resources and strategies will be required to fully implement the intention of the Smoke-free Environments Act, 1990.

rov Chapter 1 Introduction 1.1 Introduction

It has been estimated that cigarette smoking causes over 4000 premature deaths in New Zealand every year (Toxic Substances Board, 1989). The United States Surgeon stated in 1989 that cigarette smoking is:

• a cause of early death in men and women • a cause of increased overall morbidity • the major cause of bronchitis • the major cause of emphysema • the major cause of lung cancer • a major cause of coronary heart disease.

As well as the human costs associated with cigarette smoking their are accompanying economic costs. Phillips, et al. (1992) estimated the cost of smoking to New Zealand health services at $185.4 million in 1989. These are only costs to the health system, there are costs associated with illness absenteeism resulting in lost employment productivity and premature morbidity and mortality resulting in loss of income and tax revenue.

Cigarette smoking is clearly a major public health issue in New Zealand.

On August 28 1990 the Smoke Free Environments legislation was enacted. Historically there was a forty year build up to The Smoke Free Environments Act (1990). Some of the key events associated with this build up are summarised as follows:

1948 Department of Health began to mention the hazards of smoking in the print and radio media.

1954 The first Cancer Register was started in New Zealand.

1959 Department of Health produced a poster which spelt the word CANCER from cigarette smoke.

1960 A pilot survey on smoking habits in children from nine schools was conducted which revealed boys began smoking at 12 years of age and girls at 13 years of age.

1961 National Tobacco Company removed the words "Does not affect heart or throat "from tobacco packets.

1962 No cigarette advertising was permitted before 7. 3Opm on television and advertising was not accepted on the radio or television that encouraged young people to smoke.

1963 .Department of Health mentioned the policy of discouraging young people from taking up cigarette smoking in their annual report.

No cigarette advertising on television or radio.

1 1965 department of Health produced special report (No. 16) on "Smoking habits of New Zealand doctors".

1966 Minister of Health said the use of health message warnings on tobacco packets was under consideration.

1971 National Heart Foundation produced a report on Coronary Heart Disease which stated cigarette smoking as a major risk factor and recommended further promotion of non-smoking as apart of education.

1973 Voluntary agreement between the Minister of Health and three tobacco companies to ban advertising on cinema and billboards and formalise the ban of advertising on television and radio.

1974 Air New Zealand offered passengers non-smoking seats.

Warnings on cigarette packets, weak wording.

1976 Government established an Advisory Committee on Smoking and Health.

WHO recommended that Governments establish programmes for the control of smoking.

Census question on smoking.

1979 Tobacco is classified as a toxic substance under the Toxic Substances Act (1979).

Restrictions on advertising content in print media.

TV campaign to help teenagers stay non-smokers.

1980 The Tobacco Institute was founded.

1981 Health Education and Resource Project (HERP) produced non-smoking material for school children.

1982 Action on Smoking and Health (ASH) and the Tobacco Advisory Council were formed. III Smoking intervention teacher kits issued to schools

1983 First published- estimates of 3,600 deaths due to smoking. 1984 Departmental medical officer for tobacco control. II 1985 The Advisory Committee on Smoking and Health produced a report of proposals for a comprehensive policy on the promotion of non-smoking. II A

2 0 I 1986 Great New Zealand Smoke Free Week.

Smokeless tobacco banned.

Toxic Substances Board produced a report on the advertising and promotion of tobacco.

Price of tobacco products raised 54 percent.

1987 Agreement signed between the Minister of Health and Rothmans (NZ) Ltd. and WD & HO Wills (IsiZ) Ltd. outlining restrictions for tobacco product control. The agreement included the provision for inclusion of health warning messages on cigarette packs and on containers containing other tobacco products, except cigars.

Department of Health offices become smoke-free

1988 Age restriction banning sales to those under 16 included as a regulation of the Toxic Substances Act.

Department of Health publishes book entitled "The Big Kill".

Further estimate published: 4000+ deaths due to cigarettes.

Reserve Bank credit for tobacco growers stopped.

Creating smoke-free indoor environments published.

Strong varied warnings on tobacco packets.

1989 The Coalition against Tobacco Advertising and Promotion launched.

The New Zealand Health Charter launched with smoking reduction as one of ten health goals and targets.

Tobacco taxation indexed to consumer price index.

The Toxic Substances Board publishes a report "Health or Tobacco". 1990 The Smoke-Free Environments Act 1990 became law.

The Smoke-Free Environments Act (1990) has three main aims and parts: Part I : seeks to reduce exposure on non-smokers to tobacco smoke by legislating controls on smoking at workplaces, public areas and other enclosed places. Part II: seeks to legislate restrictions on the marketing, advertising, and promotion of tobacco products through sponsorship. One of the aims of Part II is to regulate tobacco advertising in all shops and in the media. Part III: involves the establishment of the Health Sponsorship Council to "promote health and healthy lifestyles through sponsorship" and to provide an alternative sponsorship source on those "individuals formerly dependent on the tobacco industry for funding or sponsorship".

1.2 What this report covers This report is divided into three distinct sections. Section one reviews the literature adolescent smoking behaviour and knowledge and details the strategies that have been used to prevent adolescents from starting smoking or smoking cessation programmes directed at adolescent smokers. Section two reports the findings of a smoking behaviour and knowledge survey conducted with 890 New Zealand adolescents between 12 and 17 years of age. The results update a similar national survey of New Zealand adolescents conducted by the National Research Bureau in 1991 (National Research Bureau, 1991). Section three focuses on Part II of The Smoke Free Environments Act (1990). The findings of a national survey of retailers support, understanding, knowledge and information requirements related to Part II of The Smoke Free Environments Act (1990) are reported.

1.3 Aims and purposes of the research

Health Research and Analytical Services, Department of Health, has been commissioned by the Public and Personal Health section of the Department of Health to conduct this research. The aims of the research are:

To examine the smoking behaviours/habits in a random sample of 12-16 year old school children.

• To examine the awareness of advertising and brand promotion of tobacco products and their association through sponsorship with sporting and non- sporting events in a random sample of 12-16 year old school children.

To determine what additional information and support retailers need to comply with the Smoke-free Environments Act (1990), especially Part II of the Act.

4 n Chapter 2 Review of Literature on Adolescent Smoking Behaviour

2.1 Introduction

"Tobacco smoke is a lethal cocktail containing the same chemicals that are found in rocket fuel, floor cleaner, paint stripper, mothballs, insecticide, ant poison, and the gases people use to commit suicide from car exhausts, and to kill people in gas chambers. And thats only naming a few". (Reid and Pouwhare, 1991) Research into the prevention (or cessation) of adolescent smoking is crucial since it appears that most smokers start smoking in their adolescent years. For example, in the U.S. 90% of all new smokers begin smoking before the age of 21 (U.S. Centers for Disease Control, 1990 A) and 20-30% of smokers become regular users by the age of 18 (Gritz, 1984).

The spontaneous quit rate in the adolescent years is estimated at 25% (among regular smokers), with the probability of cessation declining as the number of years of regular smoking increases (Gritz, 1984).

Tobacco consumption is reducing, for example, 1975 2873 cigarette equivalents per adult; 1986 2117 cigarette equivalents per adult; 1991 1783 cigarette equivalents per adult; and 1992 1600 cigarette equivalents per adult.

There is, however, concern that tobacco consumption in a subset of the population, young people, is not reducing at the same rate as for the total population (Shaw, et. al., 1991). Also, the incidence of regular smoking is higher for Maori in comparison with Non-Maori and higher for girls in comparison with boys (National Research Bureau, 1991; Shaw, et. al., 1991).

5 2.2 Aims of the literature review

The aims of the literature review were with respect to the following five topics:

(i) The smoking behaviours and habits of adolescents

To describe and review the main findings and themes of New Zealand surveys on adolescent (up to 16 years of age) smoking behaviours and habits. To establish trends/changes over time in smoking behaviours/habits.

(ii) Tobacco promotion and adolescent smoking

To describe and review the effects of tobacco promotion/advertising on the uptake of smoking by adolescents.

(iii) Proven health promotion strategies

To review health promotion strategies, programmes and/or policies directed at (i) preventing the uptake of smoking in adolescents and (ii) the cessation of smoking in adolescents. Review of this material should include the feasibility/acceptability of using these strategies in the New Zealand context.

(iv) Contemporary adolescent lifestyles and their impact on smoking behaviours and habits

To conduct an examination of sociological and historical writings that illuminate the range of lifestyles or sub-cultures currently available to young people in New Zealand, including an investigation of how these may impact on adolescents beliefs and behaviours about smoking.

(v) The sale of cigarettes to "minors"

To describe and review the extent to which retailers in New Zealand and overseas are selling cigarettes and tobacco products to "minors".

To review health promotion strategies, programmes and/or policies directed at preventing the sale of cigarettes and tobacco products to "minors". Review of this material to include the feasibility/acceptability of using these -strategies in the New Zealand context.

rol 23 Literature review methods The main sources of information included: an on-line computer search of databases for relevant books, articles, reports and newspaper clippings; • published and unpublished reports and documents provided by key informants; and • recent journals were scanned for relevant articles.

2.4 Health and tobacco use

2.4.1 Health risks for tobacco users Causal relationships have been found to exist between smoking and lung cancer, as well as cancers of the esophagus, bladder, kidney, larynx and oral cavity, pancreas and stomach. Eighty-five percent of lung cancer deaths and 30% of all cancer deaths are attributable to smoking. Plus smoking appears to be the most important modifiable factor for coronary heart disease with 30% of all coronary heart disease deaths being attributable to smoking. (Hynes, 1989) Smoking has also been found to have a lowering effect on systolic blood pressure, even in young occasional users (St George et al., 1991). Smokeless tobacco (oral snuff and chewing tobacco) has been associated with oral cancer, leukoplakic lesions, and gingival and periodontal disease (Goldsmith, 1988). Regular day long use achieves levels of nicotine in the blood, and causes changes in heart rate and blood pressure, similar to those observed in smokers (Goldsmith, 1988).

Carr-Gregg and Gray (1989) estimate that 15% of all deaths in New Zealand are attributable to cigarette smoking. This figure is an underestimate since it does not include those deaths due to passive smoking or pipe smoking. Individuals who start smoking as children put themselves at greater risk of dying prematurely or being disabled by tobacco induced diseases (Stanwick et al., 1987). Resnicow et al. (1991) suggested that approximately 35% of all smokers die prematurely and in The Big Kill (Department of Health, 1988) it is stated that at least one in four smokers die prematurely (on average 15 years ahead of their time) often after months or years of illness.

7 2.4.2 Health risks, tobacco use, and gender/ethnicity Maori men and women have one of the highest recorded incidences of lung cancer in the world; 15% of the higher overall total death rate for Maori compared with Pakeha is attributable to higher smoking rates amongst Maori (New Zealand Health goals and targets, 1989). The lung cancer rate in New Zealand women tripled between 1964 and 1986 and is still rising. Lung cancer rates for Maori women are over four times higher than those of non Maori women, and are the highest in the world. (Ministry of Womens Affairs, 1990) There are also gender-specific risks associated with smoking amon women, for example, cigarette smoking increases the risk of coronary heart disease among women several times, and among oral contraceptive users about 10 times (Hynes, 1989).

2.4.3 Health risks for the unborn child and the passive smoker Strong relationships exist between smoking during pregnancy and reduced birthweight of infants, spontaneous abortion, sudden infant death syndrome, fetal growth retardation, preterm delivery, and intellectual and behavioural defecits in the child (Hynes, 1989). Not only are there serious health risks for the smoker and the unborn child of a smoker, but also for the passive smoker. Non smokers who spend a significant amount of time in smoke filled environments, either at home or at work, may assume the same risks as light smokers. For example, Kawachi et al. (1989) estimated the total number of deaths due to passive smoking from lung cancer (30) and ischaemic heart disease (243) to be a total of 273 per year in New Zealand. Children are especially vulnerable to tobacco smoke. Children who are brought up in smoke filled homes are more likely to get blocked and runny noses, sore eyes, earache and glue ear, coughing and chest infections, asthma, and cancer. (Reid and Pouwhare, 1991)

2.4.4 Financial costs versus financial gains It has been questioned whether the financial gains (revenue from taxation and reduced health care spending on the aged because of reduced life expectancy) may outweigh the financial losses due to smoking (increased health care costs for smokers). Hodgson (1992) evaluated whether lifetime medical expenditure is greater for smokers or never smokers. The associated costs of non smoking (for example, medical care for the elderly due to greater life expectancy) were compared with the medical costs of being a smoker (for example, treatment for lung cancer). Hodgson concluded that "the cumulative impact of excess medical care required by smokers at all ages while alive outweighs shorter life expectancy, and smokers incur higher expenditures for medical care over their lifetimes than never smokers". On the basis of these findings, Hodgson argued that "reductions in the number of persons who ever smoke and the amounts smoked will benefit all payers

LV of medical care, decreasing the financial obligations of both public and private sources of funding". In New Zealand it has been estimated that each year 4,815 years of working life are lost due to cigarette smoking induced premature mortality (Gray, 1988). In 1992, excess use of hospital services caused by cigarette smoking in New Zealand was estimated to cost at least $110 million each year (March 1992 dollars) (Department of Health, 1992). DiFranza and Tye (1990) estimated that approximately 3% of tobacco industry profits in the U.S. derive directly from the illegal sale of cigarettes to children and that about half of the American tobacco industrys annual profits derive from sales to people who became addicted to nicotine as children. But despite these profits, it was found that tax revenues to federal and state governments from cigarette sales to children dwarfed governmental expenditures on smoking and health.

2.4.5 Conclusions Since every year adults die from smoking related diseases or quit smoking, new customers must be obtained so as to maintain tobacco sales. Many of these new "customers" are recruited from children and adolescents. (Stanwick et al., 1987) Children who begin smoking in early adolescence are likely to continue smoking as adults, whilst those who postpone smoking until their later adolescence are less likely to start smoking and are more likely to quit smoking as adults. (Stanwick et al., 1987) Children who begin to smoke at a young age are also more likely to consume more cigarettes daily than those who start later in life (Moss et al., 1992). Therefore all legitimate means by which smoking initiation can be delayed need to be explored. To achieve this aim it has been suggested that "a comprehensive and well-orchestrated program of education, taxation, and legislation" may be required for success (Stanwick et al., 1987). 2.5 Smoking prevalence - International literature Smoking behaviour begins primarily in adolescence. Regular smoking leads to the development of a dependence process, with cessation often difficult to achieve and maintain, therefore smoking onset is a responsibility of health professionals and educators. (Gritz, 1984)

2.5.1 Smoking prevalence amongst U.S. adults Despite the decline in overall prevalence of cigarette smoking (see table 2.1) in the U.S. (from 42.3% in 1965 to 25.5% in 1990), there has not been a corresponding decline in the actual number of adult smokers due to increases in population size (Giovinoi et al., 1992). For U.S. adults, a 1990 survey revealed that in all sociodemographic groups, the prevalence of smoking was higher among men than among women; and highest among persons aged 25-44 years, American Indians/Alaskan Natives, Non Hispanics, and persons with fewer than 12 years of education. Current smokers (defined as those who smoke one or more cigarettes per day) were found to smoke on average 19.1 cigarettes per day, with 22.9% of current smokers reporting smoking 25 or more cigarettes per day. (U.S. Centers for Disease Control, 1992 C)

2.5.2 Trends in smoking prevalence amongst adolescents

2.5.2.1 U.S. A number of studies have looked at how many U.S. adolescents smoke, how often they smoke and how much they smoke (see tables 2.2 and 2.3). DiFranza et al. (1987) found that the average age for the first use of cigarettes by adolescents was 13 years, and for snuff, 10 years, despite the legal age for purchase being 18 years in most U.S. States. A 1989 survey revealed that an estimated 1.7 million U.S. youths had smoked a whole cigarette before their 12th birthday (Moss et al., 1992). A 1989 survey revealed that the average number of cigarettes smoked by teenagers increases with age and that about three teenagers in four who were current smokers had made at least one serious attempt to quit smoking cigarettes (Moss et al., 1992). A 1991 survey found that the percentage of adolescents who had tried cigarette smoking and used cigarettes frequently increased significantly between the ninth and twelfth grade (14-18 years), with twelfth grade students being nearly twice as likely as ninth grade students to use cigarettes frequently (U.S. Centers for Disease Control, 1992 B).

10 r Table 2.1: Smoking prevalence - U.S. adults

Current smoker have smoked at least 100 cigarettes in their lifetime and currently smoke. Ever smoker have' smoked at least 100 cigarettes in their lifetime but do not smoke now.

11 Table 2.2: How often do U.S. adolescents smoke?

AUTHOR DATE AGE LAST MONTH LAST WEEK FREQUENT DAILY U.S. CDC (1991 A) 1989 12-18 15.7% 11.5%

Moss et al. (1992) 1989 12-18 40.0%

U.S. CDC (1991 B) 1990 grade 9 29.5% 9.9% grade 10 30.0% 10.8% grade 11 32.8% 12.6% grade 12 36.7% 17.7%

U.S. CDC (1992 B) 1991 grades 12.7% 9-12

Last month = reported smoking on at least 1 or more days in the 30 days preceding survey. Last week = reported smoking on at least 1 or more days in the 7 days preceding survey. Frequent = reported smoking on at least 20-25 days of the 30 days preceding survey. Daily = reported using cigarettes each day.

U.S. school grade ages: 7th, 8th, and 9th grades = 12-15 years. 10th, 11th, and 12th grades = 15-18 years. Last year senior high = 17-18 years.

12 Table 2.3: How much do U.S. adolescents smoke?

AUTHOR DATE AGE LITTLE LIGHT MODERATE HEAVY Resnicow et al. (1991) 1987 grade 8 16.1% 5.3% grade 10 26.4% 12.4%

Moss et al. (1992) 1989 12-18 16.0% 16-18 34.0% 25.0% 20.0%

U.S. CDC (1991 D) 1990 grades 9-37% 9-12 (median:31%)

U.S. CDC (1992 B) 1991 grades 70.1% 9-12

Little have tried cigarettes in the past but not in the 30 days preceding the survey. Light = reported smoking at least 1 cigarette in the 30 days preceding survey. Moderate = reported smoking at least 1 pack in the 30 days preceding survey. Heavy reported smoking at least 20 cigarettes per day.

U.S. school grade ages: 7th, 8th, and 9th grades 12-15 years. 10th, 11th, and 12th grades = 15-18 years. Last year senior high = 17-18 years.

13 Trends over time have also been identified. OMalley et al. (1988) examined substance use among American youth (18 to 24 years) from high school classes of 1976 to 1986 and found that cigarette use declined with successive cohorts; regular users increased their amount of cigarette use soon after leaving high school; and whereas a very few individuals may initiate regular smoking after high school, practically no one does so after age 21. Resnicow et al. (1991) found that among high school seniors (17-18 years), daily smoking (at least one cigarette per day) peaked at around 29% in 1976-1977 but declined to 18% by 1984. However, it seems that since 1984 there has been little change. Heavy smoking (> 1/2 pack per day) was also found to have declined from 19.4% in 1977 to 10.6% in 1988. The percentage of students who perceived smoking as very harmful increased from 51% in 1975 to 68% in 1988 and students who disapproved of people who smoke also increased slightly from 68% in 1975 to 73% in 1988. Bush and lannotti (1993) surveyed fourth grade Washington DC students in 1988/89 and 1990/91. Comparisons of data for the two periods revealed that the lifetime prevalence of smoking more than a puff of cigarettes had declined (1988/89: 13.5%; 1990/91: 11.4%) but cigarette experimentation had not (1988/89: 4.9%; 1990/91: 6.3%). Environmental variables associated with cigarette use which declined were being offered cigarettes by peers and pressure by friends to use. No declines were observed in family use, perceived friends use, or being bothered a lot if best friends use. The prevalence of smokeless tobacco use should not be ignored when discussing overall tobacco use in the United States. Goldsmith (1988) reported that smokeless tobacco products are used by an estimated 22 million people in America (only about 2% females) and many of the males who dip snuff and chew tobacco are very young. Unlike sales of cigarettes which have shown a decline, smokeless tobacco usage has remained steady or increased (Goldsmith, 1988). Glover et al. (1989) found that 23% of college students who began smoking before the age of ten were current smokers, while 61% of those who began using smokeless tobacco before the age of ten were current smokeless tobacco users. College students were more likely to switch from smokeless tobacco to cigarettes then from smoking cigarettes to smokeless tobacco. A 1990 survey revealed that 1%-20% (median:11%) of 9th to 12th grade students (14-18 years) across the United States, reported using smokeless tobacco in the thirty days preceding to the survey (U.S. Centers for Disease Control, 1991 D).

2.5.2.2 Australia An Australian survey of secondary school children (12-17 years) conducted in 1987 found that current smoking (that is, smoking at least one cigarette in the last week) rose with age to 27% in boys aged 16 years and to 30% in girls of the same age. When compared with an identical survey in 1984, it was found that the prevalence of smoking among 12-15 year Old schOolchildren had -fallen significantly. (Hill et al., 1990)

14 ID 2.5.3 Gender differences in smoking trends Gritz in 1984 argued that the evidence points to an increase in female smoking in each age group with the rate of female smoking exceeding that of the male rate of smoking without any convincing evidence of any downturn.

2.5.3.1 U.S. Smoking rates have declined in the United States since 1963, but this trend has been less apparent in adolescents, especially girls. In girls aged 17 to 18 years, smoking prevalence has increased from 1968 to 1979 and since 1979, female adolescents have smoked at rates that surpass those of male adolescents (Davis et al., 1990). Indeed, teenage girls comprise the largest percentage of new cigarette smokers in the United States (Hynes, 1989) with consistently higher smoking rates for females than for males (Windom, 1988). A number of studies have documented a higher smoking prevalence in recent years by female adolescents compared with male adolescents. Waldron et al. (1991) analyzed cigarette smoking patterns in a national (U.S.) sample of White high school seniors in 1985. Females were found to be more likely than males to have ever smoked a cigarette and among those who had ever smoked, females were more likely to have smoked more than twice. However, females were not more likely to have progressed in the subsequent stages of smoking adoption, and among current smokers, males were more likely to smoke at least half a pack a day. Females were found to be as likely as males to have quit smoking. Glover et al. (1989) found that female college students were more likely to smoke than male college students (16% versus 13%), but males were more likely to use smokeless tobacco (22% versus 2%). In a study of teenage smoking trends during pregnancy, Davis et al. (1990) found that there was a small but significant increase in the overall smoking prevalence during pregnancy between 1984 (32%) and 1988 (37%). Unmarried pregnant teenagers had a smoking prevalence of 42.8%, compared with a rate of 31.7% in married teenagers and pregnant teenagers had a much higher smoking prevalence than their non pregnant smoking peers. There are some indications however that this trend may be levelling off. Resnicow et al. (1991) found that between 1978 and 1987, daily and heavy smoking were more prevalent among female high school seniors than male high school seniors (17-18 years). In 1988, however, there were no gender differences in daily smoking, although males were slightly more likely to report heavy smoking. Among eighth (13-14 years) and tenth (15-16 years) graders in 1987, girls were slightly more likely than boys to have reported smoking in the past month (13.7% versus 12.4%). The Teenage Attitudes and Practices Survey (TAPS) (Moss et al., 1992) conducted in 1989 found that about the same proportions of boys and girls reported that they currently smoked. This trend was noted regardless of age. Among smokers 16-18 years of age, 55% of malesmokers and 46% Of female smokers met the TAPS heavy smoker criteria. Similar proportions of male and female smokers smoked on about the same number of days a month, but females reported smoking fewer cigarettes on the days that they did smoke.

15 The same survey also revealed that school dropouts who were male were more likely to report having smoked during the previous week than were dropouts who were female (U.S. Centers for Disease Control, 1991 A). A 1990 survey of 9th to 12th grade students (14-18 years) found that the prevalence of any tobacco use was significantly greater among male students (40.4%) than among female students (31.7%), especially for smokeless tobacco use (males: 19.1%, females: 1.4%). Current cigarette use (smoking cigarettes at any time during the 30 days preceding the survey) and frequent cigarette use (smoking cigarettes on more than 25 of the 30 days preceding the survey) were about the same for both males and females (33.2% vs 31.3%; 13.0% vs 12.5%). (U.S. Centers for Disease Control, 1991 B). Despite these encouraging signs, it is still too early to tell if these positive trends will continue.

2.5.3.2 Australia Woodward et al. (1989) reported that despite the overall prevalence of smoking in Australia declining over the last 15 years, rates among young women have increased. Gliksman et al. (1989) found that by 15 years of age, 32.4% of Australian girls and 26% of Australian boys had smoked at least one cigarette in the seven days before they were surveyed. In some of the age groups, the average number of cigarettes that were consumed by girl smokers equalled or exceeded that of their male counterparts.

2.5.3.3 Great Britain Reid (1985) stated that in Britain smoking has declined amongst boys but increased among girls since 1966. In a British study, Epstein et al. (1989) found that 23% of all the girls and 19% of all the boys (12-17 years of age) reported that they smoked cigarettes, 7% apparently often or everyday.

2.5.4 Ethnic differences in smoking trends

2.5.4.1 U.S. In the U.S., consistent and significant differences in smoking prevalence rates between White, Black, Hispanic, Asian, and Native American adolescents have been found (see tables 2.4 and 2.5). White adolescents have been found to start smoking earlier, for example, Headen et al. (1991) found that Whites were more likely to start smoking at age 12 and Blacks at age 14; and to be more likely to continue smoking and smoke more than either Hispanic or Black adolescents, with this difference being greatest between White and Black adolescents. White male students (23.6%) are also significantly more likely than any other group to report smokeless tobacco use (U.S. Centers for Disease Control, 1992 B). Resnicow et al. (1991) argued that this gap between White and Black smoking has widened since 1976 with Black adolescent smoking decreasing at greater rates than White adolescent smoking. Black teenagers who currently smoke have also been found to be more optimistic about smoking

16 cessation than their White counterparts (24% and 45%, respectively, predicted smoking the next year). (The U.S. Centers for Disease Control, 1991 A; Moss et al., 1992) When ethnic differences in not only smoking, but also drinking and illicit drug use among U.S. high school seniors over the period 1976-89 were analysed, Bachman et al. (1991) found Native Americans to have the highest prevalence rates overall for cigarettes, alcohol, and most illicit drugs; Whites had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for Marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Prevalence rates for daily use of cigarettes were found to have declined for all subgroups with cigarette use declining more sharply for Black than White seniors. Hence it has been consistently found that sinificantly less Black adolescents smoke than White adolescents. This finding is inconsistent with adult prevalence rates where more Blacks than Whites smoke (34% versus 29%) (Resmcow et al., 1991). Drug related mortality and morbidity are also higher among Black adults than White adults (Bachman et al., 1991) and while Black adolescents are less likely than White adolescents to smoke, it seems that Black adults are more likely than White adults to start smoking after adolescence (U.S. Centers for Disease Control, 1991 E). Bachman et al. (1991) suggested that these findings may be an artifact of the "two worlds" of drug use existing within the Black community: the extremes of abstinence at one end and heavy use/abuse at the other. Siegfried (1991) on the other hand reported suggestions that low rates of cigarette use by Black adolescents may relate to lower levels of disposable income compared with White adolescents or that Blacks have different social norms and spend their money differently.

2.5.4.2 Australia Like North America, ethnic differences have been identified in Australia. Gliksman et al. (1989) surveyed Australian school children and found that ethnic origin was a statistically significant predictor of smoking behaviour in children. Significantly fewer children of Asian ethnic origin were current smokers. Upon closer examination of the Asian data it was found that while the prevalence of smoking was very high among many Asian men, it was very low among Asian women. Guest et al. (1992) looked at the smoking prevalence of Australian Aborigines and persons of European descent in two country towns. Of the Aborigines, 64.4% were current smokers, compared with 22.8% of non Aborigines. For persons aged 13 to 54 years, using the five categories of exposure (current smokers, non smoker, <10 cigarettes per day, 10-20 cigarettes per day, >20 cigarettes per day), smoking by Aborigines was found to far exceed that of non Aborigines in all age groups. In non Aboriginal females, the highest prevalence was in the youngest gr up (560/o of those aged 13 to 17 years).

17 Table2.4: Ethnic differences in smoker status in the U.S.

AUTHOR DATE AGE ETHNICITY NEVER SMOKER ANY TOBACCO USE CURRENT SMOKER U.S. CDC 1974 20-24 White 38.6% (1991E) Black 47.1%

1988 20-24 White 28.5% Black 24.8%

TAPS survey 1989 12-18 White 52.0% (U.S. CDC, Black 63.0% 1991 A; Moss Hispanic 57.0% et al., 1992) U.S. CDC 1990 grades White 41.2% (1991 B) 9-12 Black 16.8% Hispanic 32.0%

Any tobacco use = have tried cigarettes in the past but not in the 30 days preceding the survey. Current smoker = have smoked at least 100 cigarettes in their lifetime and are currently smoking cigarettes.

U.S. school grade ages: 7th, 8th, and 9th grades = 12-15 years. 10th9 11th, and 12th grades = 15-18 years. Last year senior high = 17-18 years.

18 Table 2.5: Ethnic differences in frequency of smoking behaviours amongst U.S. adolescents

AUTHOR DATE AGE ETHNICITY LAST MONTH LAST WEEK DAILY FREQUENT

Resnicow 1988 high White 20% et al. school Black 8% (1991) senior TAPS survey 1989 12-18 White 18% 13% 42% (U.S. CDC, Black 6% 3% 22% 1991 A; Moss Hispanic 12% 9% 26% et al., 1992) U.S. CDC 1990 grades White 36% 16% (1991 B) 9-12 Black 16% 2% Hispanic 31% 7%

U.S. CDC 1991 grades White 15% (1992 B) 9-12 Black 3% Hispanic 7%

Last month - reported smoking on at least 1 or more days during the 30 days preceding the survey. Last week - reported smoking on at least 1 or more days during the 7 days preceding the survey. Daily - reported using cigarettes each day. Frequent - reported smoking on 20-25 or more of the 30 days preceding the survey.

U.S. school grade ages: 7th, 8th, and 9th grades = 12-15 years. 10th, 11th, and 12th grades = 15-18 years. Last year senior high = 17-18 years.

19 2.5.5 Conclusions Overseas surveys have observed a significant decline in the smoking prevalence of adults, accompanied by a somewhat less striking and more recent decline in the smoking prevalence of adolescents. These declines in smoking prevalence have been less marked for females than for males, although the disturbing trend for females to have higher prevalence rates than for males seems to be levelling off with recent U.S. surveys identifying few gender differences. Ethnic differences in smoking have also been identified in both the U.S. and Australia. For example, in the U.S., Whites have been found to be more likely to start smoking earlier, to be more likely to continue smoking, and to smoke more than Hispanic and Black adolescents. Whatever the reasons for the ethnic and gender differences identified in the United States, Australia and Great Britain, it can be argued that there is sufficient evidence to support the view that smoking prevention., reduction, and cessation programmes will become more effective if they incorporate ethnic and gender factors into their programmes (Rogers and Crank, 1988).

- U 2.6 Smoking prevalence - New Zealand

2.6.1 Historical Background Just over 200 years ago, tobacco was brought to New Zealand by the early Pakeha explorers and traders. Tobacco soon became popular as an article of trade and the Maori took up tobacco with enthusiasm. Tobacco was cultivated and cured by the Maori for both personal use and local trade. (Reid and Pouwhare, 1991) Prior to World War I, smoking tobacco as tailor made cigarettes was still relatively uncommon with pipes still being the most common way to smoke tobacco. But during World War I cigarettes were distributed free to soldiers and there was a huge increase in the number of young men who used tobacco in the form of cigarettes. Free cigarettes were again provided to troops during World War II. (Reid and Pouwhare, 1991) During the 1920s and 1930s there was an increase in cigarette smoking by women in the western world. It has been suggested that this may have reflected to some extent womens increased independence and freedom. It also marked the time when women first became the targets of advertising campaigns. Cigarettes grew in popularity and social acceptability during this period. (Reid and Pouwhare, 1991) Due to increasing health concerns, filter tips were introduced in the 1950s and mild and low tar brands were introduced in the late 1970s to help allay these health concerns. (Reid and Pouwhare, 1991) In New Zealand, tobacco use amongst Pakeha men became less common during the 1950s when information about tobacco related diseases first became available. This decline was not copied by Pakeha Women or by the Maori. For example, tobacco use became more popular with Pakeha women from World War I and the high rates of tobacco use by Maori men did not decline. Maori Women also have had a high tobacco usage for most of this century. (Reid and Pouwhare, 1991)

2.6.2 Smoking prevalence amongst New Zealand adults

2.6.2.1 In general One in four adult New Zealanders (25%) in 1990 were smokers with an average consumption of 12 cigarettes a day. Forty-six percent of all New Zealanders had never smoked and 29% were ex-smokers. (Hilary Commission Report, 1991) A 1991 survey (N.R.B., 1991) concluded that current smoking status has changed very little since 1989. In both 1989 and 199123% were found to currently smoke 1 or more cigarettes a day. Fifty-three percent in 1991 reported having never smoked regularly compared with 52% in 1989; and 24% in 1991 reported that they used to smoke regularly compared with 25% in 1989. Those who smoked in 1990 reported that they consumed fewer cigarettes per day on average than their counterparts in 1983 (Department of Health/Department of statistics, 1992). Actual consumption of tobacco products per person aged 15 years or over has decreased by 46% from 1963 to 1991 (Department of Health, 1992)

21 11 and since 1989 the average number of cigarettes smoked by current smokers has gone down from 13.2 to 12.8 in 1991 (N.R.B., 1991). II Regardless of whether people are current smokers or smokers who have given up, the peak age for beginning to smoke has been found to be around 15-16 years of age. Amongst current smokers, 24% began smoking some time before they were II 15; 34% at 15-16; 21% at ages 17-18; and a further 21% were older than 18 when they began. (N.R.B., 1991) II A 1991 survey (N.R.B., 1991) revealed that 86% of adults agree that the health of people can be damaged by exposure to others tobacco smoke. More smokers in 1991 agreed that tobacco smoke can be damaging to the health of non smokers than they did in 1989 (74% compared with 66%). Despite these findings, the II Hillary Commission (1991) found that 39% of non smoking New Zealanders spend an average of 3.8 hours per day in a confined space with someone else is smoking. II Eighty-one percent of adults believed that there are particular illnesses or diseases caused by smoking. The main ones mentioned were: lung cancer (46%), cancer (unspecified) (27%), heart disease (26%), emphysema (22%). Amongst current smokers, 77% nominated various illnesses caused by smoking (N.R.B., 1991). II Eighty-seven percent of both current and former smokers agree that smoking is addictive but only 77% saw their own use of cigarettes as a form of addiction. Just II over one in five smokers did not believe that their own cigarette smoking was a form of addiction. (N.R.B., 1991) II A recent Public Health Commission Report (Brown, 1993) identified recent major trends in tobacco consumption in New Zealand. During the period 1984-1992, there was a 42% decline in the tobacco products available for consumption per adult; compared with a 11% decline in the period 1970-1983. Tobacco products II available for consumption, per person aged 15 years and over, fell 10% during 1992 continuing this downward trend and in 1992, 1,600 cigarette equivalents per adult were available compared with 1,783 in 1991. In the period 1970-1985, II manufactured cigarettes as a proportion of all tobacco products steadily increased from 83% to 92%, but by 1992 this proportion had declined to 82%. During the period 1984-1992 there was a 44% increase in the amount of loose tobacco available for consumption in the period 1984-1992. II

2.62.2 Gender differences A In New Zealand, cigarette consumption has declined since 1983 but this decline has been more marked for men then for women. Since 1986, the number of women II who smoke has remained consistently higher than that of men aged 15-24 years. In both 1983 and 1990 a greater proportion of females aged 15-24 years reported that they smoked, but at ages 25 and over, similar proportions of males and females reported that they smoked. Males aged 25 and over reported an average daily -11 consumption of 16 cigarettes in 1990, two more than females of the same age. At ages 15-24, men and women alike reported smoking an average of 12 cigarettes per day in 1990. (Department of Health/Department of statistics, 1992) - 11 . U In 1991, tobacco was used by approximately 27% of males and 25% of females. The proportion of males aged 15 years and over who smoke decreased from 32% II in 1976 to 27% in 1991, while the proportion of adult females who smoke decreased from 31% in 1983 to 25% in 1991. In the 15-24 year age group, the II II 22 II percentage of female smokers was higher than the percentage of male smokers. (Department of Health, 1992) The Life In New Zealand Survey (Hillary Commission, 1990) reported that the proportion of men and women smoking did not differ but a greater proportion of women (51%) than men (42%) have never smoked. More young and middle aged women (15-44 years) were smokers (29%) than any other group of either gender. The survey also found that more men than women were subjected to passive smoking (43% versus 34%). The same survey (Hillary Commission, 1991) also reported that smoking prevalence among males increases to 25-44 then progressively reduces to 65+ years of age. Smoking prevalence among young women remains relatively high until 25-44 when it also declines over age to 65+. Fifty-five percent of men and 52% of women smokers have quit.

2.6.2.3 Ethnic differences The uptake of smoking among Maori is among the highest in the world, while the quit rate amongst Pakeha, especially Pakeha men, has greatly increased in the last 15 years (Reid and Pouwhare, 1991).

Reid and Pouwhare (1991) report that in 1981, 53.5% of Maori men and 58.5% of Maori women were regular smokers; compared with 33.1% of non Maori men and 27.3% of non Maori women. The Life In New Zealand Survey conducted in 1990 (Hillary Commission, 1991) found that 38% of male Maoris currently smoked, 24% had never smoked, and 50% of those who had ever smoked had quit. These figures compare with 25%, 44% and 58% for other New Zealanders respectively. Double the proportion of Maori women were found to smoke (44%) compared with other New Zealand women (22%). Considerably fewer of the Maori women smokers (41%) had quit compared with other New Zealand women (54%). In 1989, 61% of Maori women in the 15-34 age group smoked cigarettes compared with 44% of Maori men of the same age (Department of Health/Department of statistics, 1992). Recent surveys have shown a decline in tobacco use among Maori men down to 49.4% in 1989 and 45.1% in 1990 suggesting that fewer young Maori men are either taking up smoking or continuing to use tobacco throughout their adult lives (Reid and Pouwhare, 1991). For Maori women, however, there has been no clear evidence that smoking rates are falling: 58.5% in 1981; 62.0% in 1989; 57.2% in 1990. When the two age groups, 15-34 and 35+ were examined it was found that 60.8% of young Maori women and 5 1.7% of mature maori women were smokers in 1990. Nearly two- thirds of Maori women being regular smokers during the peak child bearing and child rearing years. These statistics suggested that smoking rates among young Maori women are not decreasing and may even be increasing although mature Maori women appear to be either quitting or dying from tobacco use. (Reid and Pouwhare, 1991) European smokers reported a higher average daily consumption of cigarettes than either Maori or Pacific Island Polynesians (Department of Health/Department of statistics, 1992). The Reid and Pouwhare (1991) report that Maori, on average,

23 smoke slightly less than non Maori; 19 per day compared with 22 per day respectively. The N.R.B. survey (1991) found that those of Maori descent were a little less likely than others to accept the dangers of passive smoking exposure. Eight percent of Europeans, 17% of Maori and 30% of Pacific Islanders disagreed that smoking is addictive. Pacific Island people were amongst those who were least likely to see their own smoking as an addiction.

2.6.2.4 Demographic differences 2.6.2.4.1 Age

Smoking incidence has been found to be highest amongst 20-45 year olds (27-29%) (N.R.B., 1991). The decline in cigarette consumption since 1983 has been more marked for older rather than younger age groups (Department of Health/Department of statistics, 1992). Older people are giving up smoking at a greater rate than younger people: 38% of 19-24 group compared with 59% of the 45-64 group; and it has been suggested that the very high proportion of people 65 + who have quit smoking (80%) is probably related to the mortality of smokers (Hillary Commission, 1990). Those aged 45 years or over are also less likely than younger people to believe that there are illnesses caused by smoking and older people (over 55 years) have also been found to be a little less likely than others to accept the dangers of passive smoking exposure (N.R.B., 1991). Those who are least likely to see their own smoking as an addiction are: 15-19 and 55+ year olds. (N.R.B., 1991)

2.6.2.4.2 Socio-economic status It has been found that the more highly educated a person is, the less likely he/she is to smoke cigarettes (Department of Health/Department of statistics, 1992). Indeed male students (73%) and females students (64%) have the highest never smoked rates (Hillary Commission, 1991). Smoking prevalence has been found to be highest amongst unemployed people (49%) of any . employment category status. Unemployed women (55%) are more likely to smoke than unemployed men (45%), with both being more than double any other category. (Hillary Commission, 1990; 1991) Smoking incidence has also been found to be very high amongst blue collar workers (32%) (N.R.B., 1991). Retired people have been found to be amongst the least likely to be smokers. (Hillary Commissions 1990) An inverse relationship between smoking prevalence and socio-economic status (SES 1-2 = high status; SES 4-6 = low status) for both genders was identified by the Life In New Zealand survey. Smoking prevalence was found to increase from

24 upper SES (1-2) 16% to lower SES (4-6) 31% for females; and from upper SES (1- 2)18% to lower SES (4-6) 31% for males. A direct relationship for quitting rates was identified with quitting rates increasing as SES goes up. For males 52% of SES (4-6) quit compared with 65% of SES (1-2); and for females 45% of SES (4-6) quit compared with 61% of SES (1-2). It was suggested that lower prevalence rates and higher quitting rates among higher SES probably reflect a greater willingness of people with higher education to accept recommended health behaviour changes sooner than others. (Hillary Commission, 1991)

2.6.2.4.3 Other Solo parents have the greatest smoking prevalence of all household structure categories (49% for men, 35% for women). Smoking prevalence also been found to be greater among rural males (30%) than urban males (24%), although no such difference has been found for women (Hillary Commission, 1991).

2.6.3 Smoking prevalence amongst New Zealand adolescents A summary of New Zealand smoking statistics for adolescents can be found in table 2.6. Approximately 50 New Zealand children take up smoking every day (Can-Gregg and Gray, 1989). Shaw et al. (1991) surveyed adolescent school children in 1975 and in 1989 and found that overall prevalence of current smokers (those whyo had smoked within the last month) had decreased significantly from 45.6% in 1975 to 33.8% in 1989. Among those who had tried cigarettes, the median age of first smoking was between 10-12 years in both surveys, among both Maori and non Maori. Oei et al. (1990) looked at the smoking behaviour of nine year old children in Dunedin and found that of those who had tried smoking, 18% had tried it in the last year, 6% in the last four weeks, and 3.5% in the last week. When queried about intentions to smoke in the future, 8.3% thought that they would smoke when they got older. Stanton et al. (1991) examined the continuity between smoking at an early age and later smoking behaviour by following a cohort of Dunedin children from age 9 to age 15 years. Childrens smoking pattern at age 9 was not found to be highly related to their smoking behaviour at age 15. The children most likely to become daily smokers by age 15 were those who had smoked within the last year at ages 11 and 13. Adolescents who had not smoked by 13 years of age were unlikely to become daily smokers by age 15 years. Oei et al. (1990) concluded that the formative period for childrens daily smoking at age 15 was from 10 to 13 years of age.

25 Table 2.6: Smoking prevalence - New Zealand adolescents

AUTHOR DATE AGE NEVER TRIED NON CURRENT INFREQUENT OCCASIONAL DAILY TRIED SMOKER SMOKER USER USER USER

Oei et al. 1982 9 35% (1990) 1990 9 41% C.A.H.B. 1991 13-17 43% 33% 76% 23% (1991) Devlin 1991 form 32% 26% 42% 15% 11% (1991) 4 Devlin 1992 form 36% 26% 38% 11% 14% (1992) 4 Mcleod et 1991 form 54% 46% 79% 21% al. (1991) 1-2

McGee and form 10% Stanton 4 (1992)

Never tried = have never puffed on a cigarette. Form 1 and 2 = 11-13 years. Tried = puffed on a cigarette sometime in the past. Form 4 = 14-15 years. Non smoker = may have puffed on a cigarette in the past but do not smoke now. Current smoker = smoke daily or occasionally. Daily = smoke one or more cigarettes each day. Occasional = do not smoke every day but had smoked in 30 days preceding the survey. Infrequent = did not smoke in the last month, but had tried smoking in the past. I-

I-

= = A 1991 Canterbury Area Health Board survey of Christchurch secondary school students (13-17 year olds) revealed that the proportion of adolescents who had tried smoking increased with age. The biggest rise occurred between the third and fourth form age group (approximately 13-14 years) but tended to level off after fourth form. As many as 6% of the total respondents reported smoking more than 20 cigarettes per week. An overwhelming proportion of respondents stated that they did not intend to smoke in the future. Almost half of the respondents (48% female, 43% male) stated that they were bothered by other peoples tobacco smoke and slightly more than this (49% female, 51% male) had actually asked someone not to smoke near them. Devlin. (1991) surveyed fourth form students in South Canterbury using an anonymous questionnaire approach and found that 31 (35.6%) of the daily smokers indicated that they wanted to stop smoking, but only 7 indicated that they wanted help to stop smoking. In 1992, South Canterbury fourth form students were again surveyed and Devlin (1992) found that for those who did smoke, most smoked 1-4 cigarettes a day compared with 5-9 cigarettes in 1991. Fifty-six percent of daily smokers said that they would like to stop smoking, compared with 35% in 1991. When asked whether they thought that they would smoke when they got older, 71% (69%, 1991) said "probably wont/definitely not"; 14% (18%, 1991) said "not sure"; 12% (7%) said "yes" or "probably will". In a survey (Mcleod et al., 1991) of form 1 and 2 Nelson students, 9% reported being regular smokers and 11.5% reported smoking sometimes. Of the total sample, 1.5% reported smoking 2 or more cigarettes per week. Of those who had tried smoking, the highest proportion stated they first tried smokingwhen 7-9 years old (28%). Nearly 12% reported that they first tried smoking before they were 7 years of age. This gives a total of 39% of students experiencing smoking by 9 years of age. McGee and Stanton (1992) surveyed Wellington fourth formers and found that among daily smokers, 70% regarded themselves as "moderate" to "heavy" smokers, while 26% saw themselves as "occasional" or "light" smokers. Over 75% of daily smokers reported trying to quit or cut down on smoking in the last year; only about in every 10 of those trying to quit reported any success. When prevalence of smoking was compared with inprevious research on samples of equivalent age, findings suggested a decrease level of smoking over recent years for both boys and girls. The National Research Bureau surveyed 1600 New Zealand teenagers aged between 10-15 years in 1989 and again in 1991 (N.R.B., 1989; 1991). In 1991 it was found that while only 4% (5% in 1989) were regular smokers, a further 25% said that they had experimented with cigarettes to some degree, most only trying them once. It was found that after age 13 there is a sharp rise in the uptake of regular smoking. Those who smoked regularly, were smoking, on average, about half a packet a week (10.9 cigarettes on average). This figure was slightly lower than the 12.7 average in the 1989 survey. Although around a third of smokers in this group were only smoking 1-5 cigarettes a week, there was another quarter smoking 21 or more a week. In 1991, 33% of young people were exposed to passive Smoke in their home compared with 38% in 1989.

27 II

2.6.4 Gender differences II Like the overseas research, New Zealand studies have also found females to be taking up smoking in greater numbers than males (see table 2.7). Stanton et al. (1991) suggest that while there has been a large decrease in the number of boys II who smoke everyday, overall prevalence rates have not changed very much from the 1960s and 1970s due to a large increase in the number of girls who smoke everyday. In a survey of 11-13 year old Nelson students, Mcleod et al. (1991) found II that higher proportions of girls than boys reported having tried smoking at least once in the past and the N.R.B. in 1991 found that girls (5%) were almost twice as likely as boys (3%) to take up a regular smoking habit. II Shaw et al. (1991) surveyed adolescent school children in 1975 and 1989 and found that the prevalence of those who had never smoked had increased from 14.4% to 30.1%, with this trend being highly significant among Maori and non Maori males UI but not evident in female subgroups. They also found that while there were no significant differences in the proportions of male (44.9%) and female (46.4%) current smokers in 1975; there were significantly more female (42.9%) than male (26.2%) current smokers in 1989. II McGee and Stanton (1992) found that for those who smoked daily, boys-smoked an average of 9.7 cigarettes and girls smoked 7.4 cigarettes (non significant II difference). The boys reported that they had been daily smokers for an average of 26 months and girls for an average of 20 months (significant difference). II In a discussion paper by the Ministry of Womens Affairs (1990) it is stated that "Young women between 15 and 25 years of age form the only age group in [II which the numbers of smokers are increasing, and women smokers now outnumber men in the younger age groups. In certain groups such as young Maori women, up to 60% are now smokers II 2.6.5 Ethnic differences II A number of New Zealand surveys have found Maori (especially Maori women) to be more likely to smoke and to smoke greater amounts than the Pakeha and other ethnic groups in New Zealand (see tables 2.8, 2.9, and 2.10). 11 Ree (1986) found that Maori female secondary school students smoked more than any other group; and that Maori respondents (both male and female) smoked more than non Maori respondents. II A survey of 10-15 years in 1989 and 1991 (N.R.B., 1989; 1991) found that experimentation was more likely among Maori than among Europeans or Pacific [II Islanders. Ethnic differences in exposure to passive smoke in the home were also found with 54% of Maori, 39% of Pacific Islanders, and 27% of Europeans reporting that someone had smoked inside their house in their presence on the day U before the survey. While 6% of all young people were found to be exposed to the smoke of three or more others, the figure was 14% for Maori. II II II 28 II Table 2.7: Gender differences in smoking prevalence - New Zealand adolescents

AUTHOR DATE AGE GENDER NEVER CURRENT INFREQUENT OCCASIONAL DAILY TRIED SMOKER USER USER USER

C.A.H.B. 1991 13-17 F 26% (1991) M 21% Devlin 1991 form F 31% 29% 39% 18% 11% (1991) 4 M 33% 22% 44% 12% 10% Devlin 1992 form F 32% 28% 38% 13% 15% (1992) 4 M 39% 22% 37% 9% 13% McGee & 1992 form F 63% 15% 9% 12% Stanton 4 M 78% 9% 5% 8% (1992)

Never tried = have never puffed on a cigarette. Form 4 = 14-15 years. Tried = puffed on a cigarette sometime in the past. Current smoker ,= smoke either daily or occasionally. Daily = smoke one or more cigarettes each day. Occasional = do not smoke every day but smoked in the 30 days preceding the survey. Infrequent = did not smoke in the last 30 days, but have tried smoking in the past. Table 2.8: Ethnic differences in smoking status - New Zealand adolescents

AUTHOR DATE AGE RACE GENDER NEVER EX CURRENT REGULAR DAILY SMOKER SMOKER SMOKER SMOKER SMOKER

Shaw 1975 form Maori F 12% 27% 61% et al. 3-5 M 9% 37% 53% (1991) Non Maori F 29% 51% 20% M 14% 59% 26%

Shaw 1989 form Maori F 14% 39% 47% et al. 3-5 M 37% 35% 28% (1991) Non Maori F 33% 35% 31% M 47% 32% 20%

McLeod et 1991 11-13 Maori F,M 61% 26% al. (1991) Non Maori F,M 81% 8% McGee and 1991 form Maori F,M 26% Stanton 4 Mixed F,M 17% (1992) Poly F,M 10% Pakeha F,M 8% Other F,M 8% Mixed = Maori/Polynesian and Pakeha. - - Poly = Other Polynesian. JUi1I1.) i-i, yai Other = Other backgrounds including Indian and Asian. Form 4 = 14-15 years Form 5 = 15-16 years Ex smoker = reported smoking in the past, but not in the last 30 dyas. Current smoker reported smoking in the last 30 days. Regular smoker = reported smoking at least 1-2 cigarettes or more in a week/month. Daily smoker = reported smoking cigarettes each day.

30 Table 2.9: Ethnic differences in adolescent smoking behaviour - N.R.B. studies

AUTHOR DATE AGE RACE CURRENT FORMER NEVER REGULAR REGULAR SMOKED SMOKER SMOKER REGULARLY

N.R.B. 1989 10-15 Maori 12% 5% 83% (1989) European 4% 8% 88% Pacific Islander 2% 6% 92%

N.R.B. 1991 10-15 Maori 9% 9% 82% (1991) European 3% 7% 90% Pacific Islander 3% 1% 96%

Current regular smoker = reported smoking at present on more than just the odd occasion (i.e. 1 or more a week, or 1 or more in the weekend, most weeks). Former regular smoker = reported that they used to smoke on more than just the odd occasion. Never smoked regularly = reported that they had never smoked except on just the odd occasion.

Table 2.10: Number of cigarettes smoked by ethnicity - New Zealand

AUTHOR DATE AGE RACE >2 PER WEEK 1-2 PER WEEK 1-2 PER MONTH 1-2 PER YEAR

Mcleod 1991 11-13 Maori 6% 11% 8% 13%

et al. Non Maori 1% 3% 4% 11% (1991)

31 Shaw et al. (1991) surveyed adolescents in a rural, largely Maori population in 1975 and 1989 and found that the overall prevalence of current smokers had decreased significantly with this decrease being most obvious in those of Maori origin. Maori were found to still smoke more often than non Maori (36.6% vs 25.2%), and this was particularly true of females (46.7% versus 31.3%). Among currently smoking Maori, cigarette consumption was found to have risen significantly (median per week: 15 versus 30), despite an overall fall in the proportion of the groups who reported smoking within the previous month (57.1% versus 36.6%). As a result, there were significantly more smokers in the high consumption group than previously (7.0% versus 12.6%), particularly among Maori females (7.5% versus 16%). McGee and Stanton (1992) found that attempts to quit or cut down on smoking were equally prevalent across the different ethnic backgrounds, suggesting that the characteristics of adolescents who smoke are much the same within different ethnic groups.

2.6.6 Conclusions Significant numbers of New Zealand adolescents are still continuing to initiate and maintain smoking behaviours. It appears that females and Maori are at particular risk prompting the need for prevention programmes to be sensitive to both gender and ethnic differences if any significant changes are to be made to the smoking prevalence rates of New Zealand adolescents.

32 2.7 Why do young adults initiate and maintain smoking behaviours? The smoking onset process may be viewed as a series of stages starting with preparation and anticipation, and moving to initiation, experimentation, and lastly to the maintenance of regular smoking (Best et al., 1988). Cleary et al. (1988) make the point that most adolescents at least experiment with smoking and that it is therefore wrong to neccessarily view initiation as equivalent to the initiation of a long smoking career. Experimenting with smoking does not inevitably lead to the establishment of regular smoking. Cleary et al. suggested that adolescents may go through several cycles of experimentation, regular smoking, and cessation. Hence they suggested that the prevention of any smoking may be futile, but that preventing the transition from experimental smoking to regular smoking may be an attainable and an important goal. It is important to remember too that a correlation between smoking behaviour and other factors does not necessarily indicate a causal relationship. Smoking may be associated with the smoking behaviour of parents and peers but if both smoking by adults and smoking by adolescents are influenced by similar and related environmental factors, then the associations noted may not be of a causal nature. (Cleary et al., 1988)

2.7.1 Correlates of adolescent smoking behaviour Adolescent smoking uptake and maintenance has been associated with a number of factors which can be grouped under eight main headings:

2.7.1.1 Peer group smoking behaviour The individuals peer group and/or peer pressure has been found to be particularly important in the initiation and maintenance of smoking behaviours (Syme and Alcalay, 1982; Gritz, 1984; Reid, 1985; Windom, 1988; Altman et al., 1989; Hynes, 1989; Armstrong et al., 1990; Perry, 1991; Wragg, 1992) Court (1993) stated that:

The teenager in mid-adolescence seeks approval from peers and identifies with them; self-esteem is influenced by their estimation. In order to belong, teenagers often feel they should conform to the behavioural expectations of the group". A developmental characteristic of adolescence is the imaginary audience, that is, the belief that they are the focus of attention, this in turn creates a concern with what others may be thinking about them. There is also a movement towards autonomy, with adolescents replacing (in the early stages of autonomy) their dependency on parents with a dependency on peers. These characteristics increase susceptibility to negative peer influence due to an over concern with acceptance by peers and the need to meet peer norms. (Wragg, 1992)

33 2.7.1.1.1 International literature A number of studies have identified a strong correlation between having friends who smoke and smoking oneself (Alexander et al., 1983; Kreuter and Powell, 1987; Cleary et al., 1988; Miller and Slap, 1989; Waldron et al., 1991). The Teenage Attitudes and Practices Survey (TAPS) (1989) revealed that teenagers with no best friends of the same gender who smoked seldom smoked (3%). However, almost half of those with at least two best friends who smoked were smokers themselves. (Moss et al., 1992) TAPS also found that 82% of current smokers reported having at least one best male friend, and 78% cited at least one best female friend who smoked. Of adolescents who had never smoked, 20% reported having at least one best male friend, and 18% cited at least one best female friend who smoked. Also almost half of those teenage smokers who were in relationships reported that their boy/girlfriend also smoked, but only 8% of teenagers who had never smoked reported having a boy/girlfriend who smoked. (Allen et al., 1993) In a Malaysian study, Kurtz et al. (1992) found that peer groups had a substantial influence on students attitudes toward passive smoking and their preventive efforts when exposed to passive smoke. Hynes (1989) found that peer pressure contributes to the initiation of smoking by girls. Adolescent females who had a best friend who was a smoker were 9 times more likely to be smokers. Armstrong et al. (1990) also found that girls who experienced pressure from friends to smoke were more likely to do so, and in boys, general susceptibility to the influence of peers, rather than to specific pressure to smoke, was associated with smoking. Headen et al. (1991) found that having a best friend who smoked increased the odds of initiating smoking over twofold for Whites but had no effect on the odds of smoking for Blacks. Peer influence was also found to be the strongest predictor of smoking in a New York Latino sample (Dusenbury et al., 1992). Therefore having peer influences thatsupport or discourage smoking is a very important factor in deciding who will start smoking and who will continue to smoke (Perry, 1991).

2.7.1.1.2 New Zealand literature Oei et al. (1990) in a study of nine year old Dunedin children found that those children who had friends who smoked were more likely to be smokers themselves, be more accepting of the habit and have more positive attitudes. Therefore the drive for conformity was found to be very strong even amongst primary school children. Children identified a variety of reasons for trying out smoking including the influence of friends (because other kids like smokers better than non smokers). Thirty percent of those who had tried smoking, did so because of family or peer models or because they wanted to join a peer group. In a survey of form 1 and 2 Nelson students Mcleod et al. (1991) found peer influence to be the most significant factor with 52% of smokers having best friends who also smoke compared with 13% of non smokers. Reasons given included pressure from friends, it seemed cool, I wanted to be one of them, bribery, I

34 wanted to look cool. Fourteen percent felt that they were unable to handle pressure from friends. Stanton and Silva (1991) looked at childrens exposure to smoking. They found that the source of the influence is more important than the extent of influence among friends and family members. In particular, the influence of friends smoking was evident at ages 9 to 15 years to the exclusion of the parental example of smoking. In a sample of Wellington fourth formers, McGee and Stanton (1992) found that daily smokers had a very high exposure to friends who smoke: 83% of daily smokers reported having two or more friends who smoke, compared to 39% of those who smoked less frequently and only 6% of those not smoking. Chetwynd (1986) looked at the characteristics of women smokers versus non smokers aged 18 to 60 years. Smokers were more likely to have partners who also smoked. A discussion paper by the Ministry of Womens Affairs (1990) also pointed to social factors - role models and peer pressure, as being important in explaining the high uptake of smoking by women. Having friends who smoke has also been pointed to as a contributory factor in explaining why Maori are more likely to start and to continue smoking tobacco. (Reid and Pouwhare, 1991)

2.7.1.2 Family smoking behaviour

2.7.1.2.1. International literature The smoking behaviour of ones family has also been found to be strongly associated with the initiation and maintenance of smoking behaviours (Syme and Alcalay, 1982; Reid, 1985; Kreuter and Powell, 1987?; Best et al., 1988; Cleary et al., 1988; Hynes, 1989; Miller and Slap, 1989; Armstrong et al. 1990; Perry, 1991; Kurtz et al., 1992; Wragg, 1992). Smoking by parents (Windom, 1988; Gritz, 1984) and by siblings (Alexander et al., 1983) have been associated with the uptake of smoking in The TAPS study (1989) found that teenagers were three times more likely to smoke (37%) if their parents and at least one older sibling smoked than if no one in the household smoked (12%) (Moss et al., 1992). It was also found that 17% of current teenage smokers reported living with an older sibling who smoked, but only 5% of teenagers who had never smoked lived with siblings who smoked. Forty-six percent of current teenage smokers reported that their parents smoked, and 36% of teenagers who had never smoked lived with at least one parent who smoked. (Allen et al., 1993) Wragg (1992) reported onresearch which suggested that the probability that a child will indicate an intention to smoke at some time in the future doubles if one parent smokes and could quadruple if the smoking parents attitude to tobacco use is considered supportive. Gliksman et al. (1989) found that parental smoking status was an important determinant of smoking behaviour in Australian school children and that this

35 II influence was more important for girls than for boys, particularly when the mother was a smoker. Hynes (1989) also found that in families where both parents smoke, 20.7% of girls were smokers compared with 7.6% of girls in families where neither 11 parent smoked. Armstrong et al. (1990) examined parental influence in the uptake of smoking and II found that girls were more likely to take up smoking if their father or sister smoked, while boys were more likely to take up smoking if their brother smoked; and that both boys and girls were deterred from taking up smoking when they II considered that their parents would be angry if they did so. Family influence was found to be the most important predictor (after peer influence) of smoking for New York City Latino adolescents (Dusenbury et al., II 1992). II 2.7.1.2.2 New Zealand literature Oei et al. (1990) identified a highly significant relationship between childrens puffing and parents smoking habits. Children of smoking parents also expressed II more positive attitudes towards smoking than those of non smoking parents. One of the reasons given for trying out smoking was influence of family ("because most of my family do"). Thirty percent of those who had tried smoking, did so because of II family or peer models. A survey by McLeod et al. (1991) also revealed a strong relationship between II parents smoking behaviour and the smoking behaviour of adolescents - adolescents who smoked were more likely to be living with adults who smoked. These findings may be important in explaining the high rates of smoking amongst Maori since Mcleod et al. also found that only 36% of Maori students lived in smokefree II homes. Mcleod et al. (1991) also found that 56% of students stated receiving smokefree II messages from home while 44% received no messages relating to the dangers of smoking. This was related to whether adults smoked or not, with adult smokers being less likely to discuss the dangers of smoking. Children who received II smokefree messages were found to be less likely to smoke. Stanton and Silva (1991) found that parental smokers may lead their children to try smoking but that it seems unlikely that parental smoking is related to children II smoking at a later age. Stanton and Silva argued that while peer influence may result in smoking, the influence of parents or older people smoking may be becoming a disincentive in this time of changing attitudes to smoking, for example, II 13-year-olds with two parents who smoked were no more likely to -smoke than those with parents who did not smoke. Research has found strong correlations between the smoking practices of rn teenagers and their parents with some research finding that the smoking habits of boys are similar to that of their father and girls to those of their mother. Siblings smoking behaviour and parental endorsement/ encouragement has also been ... I P found to be important, with a quarter of children reporting having had their first cigarette with their parents or being given cigarettes by their parents. (Reid and Pouwhare, 1991) II II I 36 ci The Reid and Pouwhare (1991) stated that: "We (Maori) have more parents, siblings and friends who smoke. We are therefore more likely to start and continue smoking tobacco. Its also harder for us to be disapproving when our children want to start".

2.7.1.3 Knowledge and attitudes about smoking

2.7.1.3.1 International literature Miller and Slap (1989) report that knowledge and attitudes about smoking have been associated with adolescent smoking. Reid (1985) points to a lack of knowledge and real understanding of the hazards as being associated with children taking up smoking; and in a British study, Alexander et al. (1983) found that initial attitude scores were indicative of future smoking behaviour and where smoking behaviour changed, attitudes also changed so that the two remained congruent. Perry (1991) found that knowledge about health, value on health and fitness, and functional meanings of health related behaviour were related to the onset of cigarette smoking. Indeed in the TAPS study (1989), current teenage smokers reported that their peers cared less about behaviours that affected their health than did teenagers who had never smoked. Of those who had never smoked tobacco, 57% cared a lot about not using Marijuana compared with 23% of current tobacco users. (Allen et al., 1993) Expressed intention to smoke in the future has also been found to be a predictor for the initiation of smoking by adolescents (Kreuter and Powell, 1987?; Brink et al., 1988; Armstrong et al., 1990). A direct relationship has been found between the percent of smokers expecting to still be smoking in 1 year and the amount currently smoked. Only 16% of occasional smokers, 46% of light smokers, and 66% of heavy smokers predicted that they would still be smoking in 1 year (Moss et al., 1992). When asked the question "Do you think you will be smoking 1 year from now?" , more than half of all teenage smokers said they would definitely or probably would not be smoking in a year. These statistics illustrate just how naive adolescents are with regard to the addictiveness of cigarette smoking. (Allen et al., 1993) Positive beliefs or favourable attitudes towards smoking have been correlated with smoking behaviour (Waldron et al., 1991). In the TAPS study (1989) it was found that:

(i) Teenagers who assigned positive attributes to cigarettes were 2-4 times more likely to be smokers than were other adolescents. For example, 46% of smokers agreed that it was safe to smoke for 1 or 2 years compared with 13% of smokers who disagreed. (Moss et al., 1992)

-The-functional utility of smoking-was--perceived--to be Tmuch greater by current smokers than by those who had never smoked - current smokers also perceived their peers as caring more about controlling their weight than teenagers who had never smoked. Current smokers (79%) cared more about keeping their weight down than did those who had never smoked (73%). Thirty percent of current smokers believed that smoking helps

37 people keep their weight down compared with only 13% of never smokers. (Allen et al., 1993) (iii) What teenagers believed to be true about smoking was clearly influenced by the benefits they perceived from smoking. Current adolescent smokers were significantly more likely to believe that cigarette smoking helps people when they are bored, helps people relax, helps reduce stress, helps people feel more comfortable in social situations, and helps keep their weight down. For current teenage smokers, the perceived functional utility of smoking clearly outweighed the risks of smoking. (Allen et al., 1993) (iv) TAPS also found that 78% of teenagers who had never smoked reported that they strongly disliked being around people who were smoking, and 94% preferred to date non smokers, but only 19% of current smokers strongly disliked being around others who were smoking, and 51% preferred to date non smokers. (Allen et al., 1993) (v) A significant number of teenagers reported having been exposed to information related to the health risks of smoking regardless of adolescent smoking status. More than 80% of both current smokers and teenagers who had never smoked said they had heard or seen something in the media recently about the risks of smoking, and more than 70% had taken a class or course at school about the health risks of smoking. More than 80% of current smokers and teenagers who had never smoked also believed that almost all doctors are strongly against cigarette smoking. Despite similar knowledge levels about smoking health risks, current smokers were more likely than adolescents who had never smoked to believe that it was safe to smoke for a year or two, that there was no harm in having an occasional cigarette, and that they could stop smoking anytime they wanted to. (Allen et al., 1993)

2.7.1.3.2 New Zealand literature Oei et al (1990) found that the children who had puffed a cigarette had a significantly more positive attitude ("smoking is good, wise and fun) towards smoking than children who had not experimented with cigarettes. Children identified a variety of reasons for trying out smoking including: they were curious or it gave them something to do. Twenty-eight percent reported that they smoked because they were bored or had nothing to do, or just to have a good time. Over 25% smoked because it was "part of becoming an adult" and 15% smoked because it make them feel happy or good. In a survey (Canterbury Area Health Board?, 1991?) of Christchurch secondary school students, students were found to have a good knowledge of how smoking affects fitness and of how passive smoking affects health. However, although 25% of respondents said they smoked, very few indicated an intention to smoke in the future. It was suggested that this may reflect a lack of understanding of the addictiveness of tobacco and supports the view that adolescents feel in control and believe they can stop smoking when they wish to.

38 In a survey of fourth form students in South Canterbury, Devlin (1991?) found that when students were asked about their intention to smoke when they were older, 70% thought that they probably would not; 7% indicated that they probably would; and 18.817o were not sure. McLeod et al. (1991) identified a number of factors associated with smoking behaviour which included:

(i) Future expectations: 69% said that no way would they smoke later on; but 1.6% thought they would smoke as adults and 30% were undecided. It was argued that these undecided students may be very vulnerable to advertising and peer pressure. (ii) Knowledge: 81.6% felt that they knew enough about the dangers of smoking.

(iii) Attitudes: when asked what they felt about others smoking, 65% felt that smoking stinks or that it made them unhappy; 35% felt that they did not mind smoking, or put up with it, or had no feelings. McGee and Stanton (1992) found that beliefs about smoking were generally negative, although there were significant differences among daily smokers, those who smoked less often, and those who never smoked. A number of factors were found to be associated with smoking behaviour including (i) approval of smoking and intention to keep smoking: daily smokers approved to a greater extent of smoking than other groups and also believed that they were more likely to continue smoking after leaving school. (ii) Beliefs about smoking: daily smokers had more positive beliefs (for example, "looks good") about smoking than did those in other groups. The smallest differences between groups were in terms of beliefs about the value of smoking,its effects on fitness, how hard it is to stop, its effect on weight, peer popularity, and others health. The largest differences were on the dimensions of looks (for boys), relaxation, taste and feeling better.

2.7.1.4 Demographics

2.7.1.4.1 International literature Another of the main factors associated with the initiation, experimentation and maintenance of smoking are demographic correlates (Best et al., 1988; Miller and Slap, 1989) including:

(i) Alexander et al. (1983) found that having a relatively large amount of money to spend each week is one of the factors which can distinguish between those who take up smoking and children who remain non smokers. Allen et al. (1993) also reported on the basis of the TAPS study (1989) that teenage smokers had more spendable income than - teenagers who had never smoked. More than 45% of current smokers had more than $20.00 a week to spend any way they wanted to, compared with half as many teenagers who had never smoked.

39 II (ii) Children from lower socioeconomic families are more likely to smoke (Cleary et al., 1988). Hynes (1989) found that working class females are II more likely to initiate smoking behaviours. (iii) Variations by region and race (Cleary et al., 1988). 11 (iv) Children from broken homes smoke more than those from intact two parent homes (Cleary et al., 1988). [II (v) Adolescents who work a substantial number of hours at a job, date more often, and spend more evenings outside of their families home are associated with greater drug use (Cleary et al., 1988). The TAPS study II (1989) found that more than 90% of teenagers who had smoked, compared with 57% who have never smoked, had had a steady boyfriend or girlfriend (Allen et al., 1993). II

(vi) The TAPS study (1989) found that almost twice as many teenagers who smoked were left alone at home without parental or adult supervision for II 10 or more hours a week as were teenagers who had never smoked. (Allen et al., 1993) There seems to be a direct relationship between number of hours an adolescent is left at home unsupervised before and after school II and their current smoking behaviour. Eighteen percent of those left alone for 15 hours or more a week currently smoked compared with 8% of those who were never without adult supervision. (Moss et al., 1992) II (vii) The TAPS study (1989) also revealed that more than half the teenagers who smoked attended religious services rarely or never, compared with fewer II than a third of teenagers who have never smoked (Allen et al., 1993). Waldron et al. (1991) found that smoking adoption was inversely related to commitment to religion and that this inverse relationship was stronger for I females than for males. II 2.7.1.4.2 New Zealand literature Chetwynd (1986) reported that female smokers were more likely to come from a blue collar background. II The Ministry of Womens Affairs (1990) pointed to smoking being closely associated with economic stress (unemployment and poverty) as important in II explaining the high rates of smoking among Maori women (63%) as opposed to non Maori women (31%). One parent families have a higher than expected proportion of young smokers which is important with so many of Maori coming from such families. (Reid and Pouwhare, 1991) [1 The greatest concentration of young smokers (11-12 year olds) has been found in small towns, 16% compared with 8% in large urban centres. Children from rural areas were the least likely to smoke. (McClellan, 1987) II II II 40 II 2.7.1.5 School related factors

2.7.1.5.1 International literature A number of school related factors have been associated with adolescent smoking behaviour: (i) Lack of academic achievement and alienation from the values of the school (Reid, 1985; Hynes, 1989; Davis et al., 1990). Cleary et al. (1988) found that self described college bound students are far less likely to smoke. Among high school seniors in 1987 who did not plan to attend 4 years of college, the daily smoking prevalence was 27.4%, compared to 13.4% among those who planned to complete 4 years at college. Similarly, the prevalence of heavy smoking was greater among students who did not plan to complete 4 years of college (18.4%) than among students who did (6.8%). (Resnicow et al., 1991) Among youth 17-18 years of age in 1989, the prevalence of smoking during the previous week was substantially higher among school dropouts than among school attenders/graduates (U.S. Centers for Disease Control, 1991 A). In the TAPS study (1989), of adolescents who classified themselves as "above average" students, only 10% currently smoked; in contrast, 44% of "below average" students smoked (Moss et al., 1992). More current smokers than non smokers reported liking school less, doing poorly in school, and percieved what they learned in school as less useful to them later in life. Current smokers also missed more time from school in the two weeks prior to the interview and reported cutting school more often. (Allen et al., 1993) Waldron et al. (1991) found that smoking adoption was inversely related to commitment to school and that this inverse relationship was stronger for females than for males.

(ii) School policies regarding smoking and teachers smoking habits (Reid, 1985). Porter (1982) compared two British boarding schools for boys with different disciplinary policies in respect to cigarette smoking. Questionnaires were sent to recent "old boys" of the two schools to determine their present smoking habit. Significantly more responders smoked who had been to the less strict school (39% versus 30%). Porter suggested therefore that measures which reduce the exposure of an uncommitted adolescent to peer group smoking decrease the chances of tobacco dependence in adulthood. Crow (1984) administered a questionnaire to students at two U.S. suburban high schools, similar in size and socioeconomic status. One of the schools provided a smoking area for students, the other did not. Findings suggested a possible relationship between providing a smoking area for students and an increase in the number of teenage smokers.

41 (iii) School activities.

Miller and Slap (1989) noted the importance of school activities in relation to smoking behaviour. The TAPS study (1989) found that the level of involvement in organised activities was important. Almost twice as many adolescents who did not participate in organized team sports currently smoked (21%) as did those involved in competitive sports activites (12%). (Moss et al., 1992)

2.7.1.5.2 New Zealand literature No information was found regarding school activities and the smoking behaviour of adolescents in New Zealand.

2.7.1.6 Personal factors

2.7.1.6.1 International literature A number of personal factors have been associated with adolescent smoking behaviour (Reid, 1985; Best et al. 1988; Miller and Slap, 1989) including: (i) Smokers have a slight tendency to be more extrovert and neurotic than non smokers (Reid, 1985).

(ii) Smoking has been linked to self-esteem and a desire to appear mature (Reid, 1985; Kreuter and Powell, 1987). During adolescence there is a movement towards identity formation - the desire to develop a sense of self as distinct from parents and also to seek recognition and independence associated with adult status. This search for adult identity creates an increasing awareness of the markers of adult behaviour - including smoking. (Wragg, 1992) (iii) Ability to cope with stressful situations (Kreuter and Powell, 1987). (iv) Low self-efficacy to refuse offers of cigarettes (Kreuter and Powell, 1987; Perry, 1991).

(v) Risk taking behaviour and rebelliousness. Court (1993) stated that adolescence is a time of risk-taking with feelings of invulnerability or not caring about the consequences underlying much of teenagers social activity. Collins et al. (1987) found that the risk taking/rebelliousness and perceived smoking prevalence subscales were predictive of young adolescent cigarette smoking. Social disapproval and motivation to comply subscales were significant predictors of the transition out of the never tried group. The TAPS study (1989) found that adolescents who smoked were more likely to be involved in risky behaviours than teenagers who had never smoked. Teenage smokers were twice as likely to have been involved in one or more physical fights in the past year and ridden a motorcycle or minibike often or sometimes in the

42 past year. Smokers were almost three times more likely to rarely or never wear seatbelts and six times more likely to have ridden in a car by someone who had been using drugs or drinking than those teenagers who had never smoked. Teenagers who smoked tobacco also reported knowing more people who used chewing tobacco, snuff, marijuana, crack or cocaine; drank alcohol; and had sex than did teenagers who had never smoked. At least half of all current smokers said that most or all of the people they knew who were their age smoked cigarettes, drank alcohol, got drunk at least once a month, or had sex. (Allen et al., 1993) Davis et al. (1990) suggested that smoking during adolescence often exists as part of a cluster of behaviour problems such as illicit drug use and increased sexual activity. Antisocial behaviour is associated with adolescent substance use, with antisocial behaviour in early adolescence being a more powerful predictor of later drug misuse problems than the existence of antisocial behaviour in early childhood. Deviant attitudes, beliefs and behaviours have also been associated with drug taking behaviour, for example, a predisposition towards rebellion, independence and non conformity have been associated with drug use. (Wragg, 1992) (vi) Unrealistic optimism. Greening and Dollinger (1991) found that, in general, adolescent smokers do not perceive themselves at greater risk of death than their non smoking peers. A subgroup of adolescent smokers who report high attention to the news and high sensation seeking males may be especially vulnerable to denying the potential risks. The authors relate this to the possibility of an "invulnerability syndrome" or "unrealistic optimism" in adolescents. Smokers who are informed of the risks may deny personal vulnerability because of anxiety about mortality or other contributory cognitive processes. High sensation seeking tendencies led to lower perceived risks for males but not for females. Wragg (1992) argued that young adolescents may not have developed their cognitive skills sufficiently to understand the "full implications of logical and hypothetical arguments that extend over an enlarged time frame". Adolescents may appreciate the fact that tobacco use is harmful and a health risk, yet find it difficult to focus on what could happen in the future, or even accept that the long term effects of smoking can affect them. Added to this is the personal fable: a belief in personal uniqueness which may lead to beliefs in invincibility - it can happen to others but not to me. Both of these characteristics of adolescence result in a failure to appreciate the dangers associated with tobacco use and recognise that they could be harmed. (vii) Social and family functioning. TAPS (1989) found that among adolescents who said that they discussed serious problems with their parents, only 11% currently smoked. In contrast, proportionately more than twice as many adolescents who confided only with friends were smokers (23%). (Moss et al., 1992)

Studies indicate that deviant behaviour. and drug use is more likely to occur in families where relationships are poor, consistent parental discipline is applied and disturbed patterns of family management occur (Wragg, 1992).

43 (viii) Teenagers who currently smoked were tired; had trouble sleeping; were sad or depressed; felt hopeless, tense, or nervous; and worried more often than teenagers who had never smoked. (Allen et al., 1993) Hynes (1989) suggested that factors contributing to smoking initiation by girls include smoking as a way to alleviate feelings of anxiety, to help in the avoidance of behaviours which are considered to have worse consequences (for example, overeating), or to alleviate lack of autonomy and consequent feelings of frustration. Waldron et al. (1991) suggested that females being less likely to participate in sports, athletics or exercise; and having poorer eating and sleeping habits may contribute to the greater smoking adoption rates (For example, females may be using smoking as a way to keep their weight down).

2.7.1.6.2 New Zealand literature McLeod et al. (1991) found self esteem to be a very significant correlate of smoking behaviour. A higher percentage of those who felt lousy about themselves were smokers. Some indicated stress or social situations as reasons for using tobacco to aid confidence/coping. Curiosity was also given as a main reason for trying out smoking, although nearly 10% stated that they tried smoking because they were bored. Chetwynd (1986) noted that female smokers were more likely to report family problems and depressive symptoms; and make excessive use of other dependency type substances (alcohol, tea, coffee). McGee and Stanton (1992) found that girls were more likely than boys to emphasise that smoking was relaxing, made them feel better and gained them friends, suggesting gender differences as reasons for smoking. The Ministry of Womens Affairs (1990) also points to relief of stress, role conflict and self confidence (for example, body image) as being important factors in women continuing to smoke. Reid and Pouwhare (1991) stated that:

Women smoke for different reasons than men. We are more likely to start in response to stress. Men are more likely to enjoy a cigarette as part of relaxing. Women use tobacco to cope with anger and frustration, with depressing and conflicting demands, with conflicts in body image, and often to claim some time for ourselves Mitchell (1983) found that when Maori fifth form students in Gisborne were asked about their cultural identity. Those who knew their iwi and their marae, and frequently attended hui were classified as having a high cultural identity. These students were found to have significantly higher levels of smoking (31%) compared with those who were classified as having a low cultural identity (14%). It was felt that this might reflect "increasing exposure to peer pressure and their closer identification with a culture in which there are higher levels of smoking amongst adults".

44 2.7.1.7 Advertising

2.7.1.7.1 International literature A number of researchers have pointed to advertising which glamorizes smoking as being a strong force in encouraging adolescents to start and maintain smoking (Syme and Alcalay, 1982; Reid, 1985; Windom, 1988; Altman et al., 1989; Perry, 1991). Both explicit advertising on the part of the tobacco industry utilizing cultural values that favor smoking and implicit advertising by such influential persons as film stars, TV personalities, teachers, and doctors are important (Syme and Alcalay, 1982). Alexander et al. (1983) found that approving of cigarette advertising was one of the factors which can distinguish between smoking adopters and children who remain non smokers. The TAPS study (1989) indicated that adolescent smokers are significantly more likely to believe that cigarette smoking helps people when they are bored, helps people relax, helps reduce stress, helps people feel more comfortable in social situations, and helps keep their weight down (Allen et al., 1993). Such positive perceptions can be at least partly attributed to positive advertising by the tobacco industry. Advertising helps to promote smoking as representing a desired set of personality characteristics (for example, independence, assertion) (Gritz, 1984) and "through cigarette advertising, adolescents receive the message that smoking is associated with social acceptance, attractiveness, being an adult, being athletic" (Brink et al., 1988). Hynes (1989) points to tobacco ads in womens magazines which portray smokers as healthy, glamorous, sociable, slim, and independent as being an important contributory factor in smoking initiation by adolescent females. Advertising is an important channel through which social norms are communicated. Social norms are in turn important in influencing smoking uptake and maintenance. Koong et al. (1991) compared smoking prevalence in the U.S. and Taipei City and found that the prevalence of current smokers among women was only 8% in Taipei versus 25% in the U.S. It was suggested this may be due to smoking being less socially acceptable for women than men in Chinese culture. As Taiwan becomes more westernized, it was felt that changing social values might lead to increased smoking among women in the near future.

2.7.1.7.2 New Zealand literature Oei et al. (1990) found that the majority of children were able to make decisions o whether smoking was good or bad, clean or dirty etc, but decisions on whether it was beautiful or ugly were not so clear. It was suggested that such confusion may be attributable to media portrayals of cigarette smokers as young and attractive, and set against a backdrop suggesting a real fun time". McGee and Stanton (1992) found that smokers tended to have less negative attitudes towards advertising and sponsorship.

45 I Advertising and sponsorship have been identified as being important in explaining womens increasing uptake of smoking. Women and young girls have been the target of the tobacco industry for the past 50 years (for examVle, the Benson and I Hedges fashion awards) with advertising emphasising emancipation and independence, slimness, sexiness, friends, freshness, cleanness". The femininecigarette (slim, filter-tipped, low-tar, and mentholated cigarettes with II names such as Fleur/ Vogue) were especially designed to appeal to women and to keep women smoking by supressing health concerns. (Ministry of Womens Affairs, 1990) I Reid and Pouwhare (1991) argued that women have been the focus of tobacco advertising working at a subconscious level, "emphasising images of independence, slimness, social and sexual success, freshness, health and fitness". I 2.7.1.8 Availability I A number of researchers have pointed to the availability of supplies, especially illegal sales by tobacconists as being important in the uptake of smoking by adolescents (Reid, 1985; Kreuter and Powell, 1987; Hynes, 1989; Hoppock and HI Houston, 1990; Perry, 1991). It is patently obvious that even if adolescents desire to smoke, this is not possible without access to the tobacco itself. Ii

2.7.1.8.2. New Zealand literature In a survey of Nelson students, McLeod et al. (1991) found that 44% got the I cigarettes from their friends; parents (23%); other (23%); brothers or sisters (12.8%); get someone else to buy them (9.2%); cousins (7.1%); and 10.5% stated buying at a shop despite the illegality of this practice. I The N.R.B. (1991) found that 14-15 year olds do not seem to have much trouble in purchasing cigarettes for themselves from shops (69% of this age group were found I to obtain their cigarettes in this way). Friends packs were also a major source, followed by family members packs (mainly a parents pack). Availability is discussed as part of the presentation of findings of the student smoking habits survey conducted as part of this report. These findings are presented in the next I chapter. I 2.7.2 Conclusions Miller and Slap (1989) argued that "the weight of the literature supports a strong and consistent association with adolescent smoking for only three variables: I parental smoking, peer smoking, and sibling smoking". Reid (1985) also stated that the main influences are adults, especially parents, followed by peer influence, and then by school policies, including smoking by teachers. I Best et al. (1988) suggested that the relative influence of different factors vary according to smoking stage. They argued that demographic and social influences are important in the early stages of smoking, but as experimentation becomes more frequent, psycho-social factors have a developing impact; with the final transition to regular smoking being more pharmacologically based as the nicotine dependence develops. Personality and intrapersonal factors mediate social HI environmental influences and that demographic variables may also impinge on the I I 46 I onset process. Once beyond the preparation and anticipation stage, the relative influences of the social environment, intrapersonal factors, and physiological reactions may be contingent on the function of smoking for the individual. During the transitional period between childhood and adulthood, adolescents are trying to disentangle themselves from the influence of an identification with their parents; establish stronger links with their peers; and establish a sharper and more independent self-identity. "Smoking is a symbolic vehicle for many of these efforts" (Syme and Alcalay, 1982). Discrepancies exist between smoking behaviour and attitudes (for example, that smoking damages your health) because smoking is biologically or psychologically addictive, or both; smoking is perceived as a pleasurable, relaxing, helpful behaviour; and smoking is perceived as sociable behaviour -a way of establishing links with other people and being "one of the gang" (Syme and Alcalay, 1982). The factors which influence smoking uptake and maintenance by adolescents must be addressed if we are to prevent children from taking up smoking.

2.8 Smoking prevention - International and New Zealand

"If tobacco were discovered tomorrow, no government in the world would permit its sale, let alone its active promotion, because of its toxic nature" (Carr-Gregg and Gray, 1989). If the decision about smoking can be delayed until adulthood, choosing to become a smoker is unusual (DiFranza et al., 1987), therefore interventions aimed at adolescents may play a very important part in the prevention of smoking amongst adults. The central aim of public policy in the control of cigarette smoking should be to minimize the health damage of cigarette smoking, with a secondary aim being to minimize the economic dislocation resulting from the achievement of this health goal (Breslow, 1982). Intervention strategies focus on either changing the individual or changing the environment in which the individual operates: 1. Individual: (i) school education programmes for both prevention and cessation of smoking; (ii) media campaigns, for example, anti smoking advertisements. 2. Environmental: i) restricting the sale of tobacco to minors; ii) taxation of tobacco; iii) banning cigarette advertising; iv) limitations on where smoking is allowed;

Essentially

prevention must address the individual and the environment in which the individual behaves and decides about lifestyle and health issues. This means providing the individual with the best possible skills to negotiate a hazardous environment. It also means stressing efforts to make the environment less hazardous" (Wallack and Corbett, 1987). The efficacy of each of these interventions will be evaluated in turn and suggestions will be made as to how such interventions may be made more effective and be implemented in New Zealand.

48 2.9 School based educational programmes Windom (1988) suggested that

"the best opportunity to teach our youth about the adverse consequences of smoking (including health and cosmetic effects) is in school" Schools need to have both: (i) smoking prevention and cessation programmes; and (ii) policies which create a smokefree environment within the school grounds.

2.9.1 Smoking prevention programmes - historical background The earliest school based smoking prevention programmes, that is, the so-called traditional approaches which focused on either changing knowledge (informational model) or attitudes (affective model), were largely based on the idea that if adolescents had the correct information about the dangers of smoking, they would not take up the practice. These programmes were found to be largely ineffective as although they had a significant impact on knowledge, they had very little impact on values and attitudes and practically no impact on behaviour. (Wallack and Corbett, 1987; Cleary et al., 1988; Bremberg, 1991; Edmundson et al., 1991; Wragg, 1992) Later programmes have taken more psychosocial approaches to prevention. Such programmes have been found to be more successful, being at least modestly effective across a variety of settings, times, and populations. These social psychological approaches include the social influences model, the cognitive behavioural model, and the life skills model. (Edmundson et al., 1991) The social influences model includes four main components:

(i) information on the negative social effects, short term physiological consequences of tobacco use, short and long term health and social consequences;

(ii) information on the social influences that encourage smoking among adolescents, particularly peer, parent, and mass media influences;

(iii) correction of inflated normative expectations of the prevalence of adolescent smoking;

(iv) training, modeling (typically using video or film or same a ge peers), rehearsing, and reinforcing of methods to resist those influences and to communicate that resistance to others, particularly peers. (Best et al., 1988; Edmundson et al., 1991) The cognitive behavioural model adopts the basic social influences model and adds role playing, rehearsal, and reinforcement of pressure resistance skills. It includes problem solving, decision making, self control methods, and self reward methods. (Edmundson et al., 1991)

49 The life skills method incorporates the four elements of the social influences model; the decision making, problem solving, self control, and self reward strategies from the cognitive behavioural method; and methods to develop greater autonomy, self-esteem, and self confidence from the affective model. (Ednaundson et al., 1991) Edmundson et al. (1991) report that over time there has been a gradual merging of the three psychosocial models. They state that the best school based curricula include social skills training in dealing with the social environment, and programmes that include parent and community involvement are more successful than those that do not. Best et al. (1988) in their review of smoking prevention programmes for adolescents also concluded that social influence curricula can be effective - at least with some youth.

2.9.2 Efficacy of school based smoking prevention programmes Reid (1985) suggested that prevention is more effective than cure since few school education programmes have any effect on existing smokers. They also report that cessation programmes with teenagers may be of little value, partly because of continuing peer pressures. Rundall and Bruvold (1988) conducted a meta-analysis of 47 smoking school-based intervention programmes published after 1970. It was found that smoking interventions had modest effects on immediate behavioural outcomes. All but one of the smoking programmes reviewed successfully increased knowledge regarding the risks of these behaviours and in 29 of the 33 smoking studies students attitudes were successfully changed. Innovative interventions relying upon social reinforcement, social norms, and developmental behavioural models were found to be more effective than traditional "awareness" programmes designed to inform adolescents about the health risks associated with tobacco use. Rundall and Bruvold point out that changes in knowledge do not always correspond to attitude change or behaviour change, both of which are more difficult to change. A National (U.S.) Cancer Institute-convened expert advisory panel concluded fromm their review of the evidence that U.S. school based smoking prevention programmes have had consistently positive effects, though these effects have been modest and limited in scope. "They have been particularly effective in delaying the onset of tobacco use and less successful in targeting high risk and minority youth". (Glynn, 1989) Walter et al. (1989) evaluated the efficacy of the school based, teacher delivered "Know Your Body" programme which was developed and implemented by the American Health Foundation in 1975. This programme aimed to modify favourably the population distributions of risk factors for chronic disease through changes in diet, physical activity and cigarette smoking. The programme was found to be feasible and acceptable to school personnel, students, and parents, and appears to have had favourable effects on prevention related knowledge , dietary intake, obesity, blood cholesterol levels, and the rate of initiation of cigarette smoking among diverse populations of school children in the New York City area.

In an Australian study conducted by Armstrong et al. (1990), the efficacy of peer led programmes in preventing the uptake of smoking by children was assessed. A randomized controlled trial of a school based educational programme for the prevention of smoking in children who were in their seventh year in school was

50 conducted in 1981. Both the teacher-led and peer-led programmes were identical with both programmes aimed at increasing childrens knowledge of the effects of smoking, their awareness of non smoking and to provide them with training in ways to resist pressures to smoke. The programme was divided into 5 sessions. From a two year follow-up, results confirmed an earlier report that both teacher- led and peer-led programmes result in a reduction, to about the same degree, in the uptake of smoking by girls, while only the teacher-led programme appears to be effective with boys. In girls, both types of programme maintained their effects over the two years of follow-up, while in boys the effect of the teacher-led programme was reduced substantially by the second year of follow-up and appeared to be confounded with other variables. Studies have also assessed teacher support for school based smoking programmes. Newman et al. (1991) asked teachers how they felt about the British "Smoking and Met school programme. The great majority were positive about its classroom utility, including the innovative use of group leaders selected by their classmates. Fewer teachers, however, were optimistic about its likely impact on pupil smoking. Teachers were important in contributing useful suggestions for future modifications to the project. Programmes based on social psychological models that are carried out at an age immediately preceding ordinary onset of smoking have consistently been found to be successful with effects even showing 2-3 years after the intervention (Bremberg, 1991). Elder and Young (1991) present pilot data on the use of a direct behaviour modification procedure for use in schools. An incentive system (the fresh mouth contest) was devised whereby students could, upon verification with a carbon monoxide breath exam, win prizes for being non-users of tobacco. Students were given the opportunity to have their breath examined during three surprise visits (over 10 weeks) by spot-checkstaff, and students received feedback at each spot- check regarding their class use rates. Prizes included duffel bags, posters, pens and sports equipment donated by community businesses. The class that demonstrated the greatest reduction in tobacco use received a prize for the whole group to share. The prevalence of past weeks use of tobacco among intervention students dropped quickly during the first four weeks of the study, from 4.8% to 3.3%, but rose to 3.6% by the end of the semester. In contrast, 4.4% of the control students used tobacco during the past week at the beginning of the semester, rising to 6.6% by the end of the semester. This difference approached but did not reach statistical significance. While equivalent numbers of intervention and control students intended to use tobacco in the future at baseline, 15.8% of the control students and 9.8% of the intervention students indicated the same desire at the end of the intervention (statistically significant). About 73% of the students indicated that they enjoyed the programme a lot. Elder and Young state that this programme is a cost effective strategy for changing behaviour. Quine et al. (1992) compared the drug awareness of two groups of primary school children in Australia; one group had attended a drug education and life skills programme prepared and delivered at the Life Education Centre external to the school. The basic aim of the programme was to reduce the prevalence of drug abuse by generating an appreciation and respect of the body, through an understanding of how the body works and seeing the way drugs can affect this. The programme examined the reasons why people use drugs and explored positive

51 alternatives to drugs. There was also a critical awareness of advertising techniques and effects of peer group pressure. The programme aimed to develop skills that enable children to make responsible decisions concerning themselves and their bodies. The programme was designed for each school class to visit once a year to receive the programme relevant to that classes year. Each programme took 60-90 minutes to complete. The programme was found to be very effective when measured by the vivid recall the children had of the event, by the amount of understanding shown in what they learned and perceived as the main messages, and by the enjoyment and satisfaction they experienced. Programme attendance was found to be an independent predictor of knowledge but not of intentions to drink or smoke and the long term benefits of the programme on future drug usage was also unclear. Wragg (1992) evaluated an Australian pilot drug education programme which comprised of four sections or stages:

(i) Six information and discussion modules presented to the participants by the researcher and class teacher. These modules were designed to increase awareness of drug use from a psychosocial perspective; develop students awareness of social, media, and peer pressure to use drugs; help students to investigate alternatives to drug use and learn skills of systematic decision making and methods of coping with peer pressure. (ii) Students were asked to develop their own group responses to the teaching units, for example, create an advertisement for a drug free, healthy lifestyle. (iii) Peer led discussion of each groups response video or artwork. Parents, teachers, and all year level peers were involved as the audience and as participants in the discussion. Parents were also involved in a two-session programme that was run concurrently with the school programme and peer led discussion. The display of the videos and artwork became the third and final parent session. Participants presented their videos and artwork in front of parents and peers and asked to debrief and discuss their presentations.

(iv) One year after the conclusion of stage 3, the videos, artwork and other material were given back to the students from the original programme. The returning students acted as peer leaders in demonstrating and debriefing their responses to last years programme to the new students. The overall conclusion regarding the differences between intervention and non- intervention group tobacco use for both the longitudinal sample analyses and for the larger cross sectional analyses was that intervention group subjects were less likely to begin using tobacco (for example, 20% more non-intervention subjects had tried smoking), tended to smoke tobacco less frequently, and appeared to smoke fewer cigarettes than non-intervention group subjects. Nutbeam et al. (1993) in a British study evaluated under normal classroom conditions two school smoking education programmes:

(i) The family smoking education project was based on a Norwegian programme which was intended for use with students aged 11-12 years and involved an average of three hours of teaching over a series of classroom

52 lessons. The lessons were reinforced with a booklet for the pupils and a separate pamphlet for the parents which encouraged them to discuss smoking with their children.. The project focused on the immediate health impact of smoking on the students and encouraged parents to reinforce the messages from school and to show disapproval of smoking. (ii) The smoking and me project was based on the Minnesota smoking prevention programme. The British version was based on a series of five lessons intended for secondary school students aged 12-13. There were no pupil project materials and the lessons focused on the social consequences of smoking and on peer, family, and media influences on smoking. Emphasis was also placed on practising skills for managing social situations in which smoking occurs. The 39 schools in the study were allocated to one of four groups: the family smoking education project, the smoking and me project, both project in sequence, or no intervention at all. All first year students were assessed on three occasions (before teaching, immediately after teaching, and at one year follow-up) for self- reported smoking behaviour (backed up by saliva samples) and changes in relevant health knowledge, beliefs and values. No consistent significant differences in smoking behaviour, health knowledge, beliefs, or values were found between the four groups. Nutbeam et al. (1993) suggestedthat more comprehensive interventions than school health education alone will be needed to reduce teenage smoking. They point out that the family smoking education project was successful in Norway where controls on the price, availability, and the promotion of tobacco products also existed.

2.9.3 Smoking cessation programmes - historical background In the late 1950s, cessation methods were primarily educational or medication based. The leading programmes in the 1960s and 1970s were 5 day plans, group discussion, and conditioning based procedures such as rapid smoking and satiation. Other popular treatments in the 1970s were self help in the form of "how to quit" manuals, books, filters, and over-the-counter drug products; group therapy; professional counselling; hypnosis; and cognitive based, self management approaches. The approaches that were emphasised in the 1980s included self help, multiple component programmes, hypnosis, acupuncture, physician advice and counselling, nicotine chewing gum, skills training and relapse prevention, and mass media and community programmes. (Schwartz and Thompson, 1991) Most of the early smoking cessation clinic approaches focused on changing smokers to enable them to alter their behaviour and to resist environmental influences to smoke. Currently the emphasis has shifted to altering the smokers environment in ways that will promote cessation and facilitate long term abstinence. (Schwartz and Thompson, 1991) Schwartz and Thompson state that "multiple channels and approaches to all sectors of the social environment characterise the state of the art in comprehensive control of tobacco use".

53 2.9.4 Efficacy of school based smoking cessation programmes "Policy and other environmental strategies may shift social norms and change attitudes towards smoking such that some people will quit (or not start) with their own resources; however, many people, especially heavy smokers, will need the assistance of some kind of clinical seivice (Edmundson et al., 1991) Smoking cessation may be very important in reducing the risk of smoking to ones health. For example, Kuiler et al. (1982) report that cigarette smoking cessation is associated with decreased risk of heart attack and cancer and improvement in pulmonary function. Essentially, the earlier one ceases smoking the better. Benfari and Ockene (1982) report that a number of conclusions can be made from reviews on smoking cessation strategies:

"(i) almost any intervention can be effective in eliminating smoking behaviour;

(ii) numerous approaches covering a wide range of techniques have been used;

(iii) short term success rates of 70-80% are not unusual for many methods;

(iv) long term rates generally deteriorate to no better than 30-40 01o, with some being little better than the 20-30% noted more than 10 years ago;

(v) little attention has been paid to the maintenance of abstinence;

(vi) multicomponent techniques have shown the most promise, reliance on a one component approach is generally not successful;

(vii) although some strategies and some multicomponent packages have proven to be more effective, the results are often not replicated;

(viii) the unaided use of pharmacologic regimens is ineffective. Thus, the problems of smoking modification extend beyond those arising from pharmacologic dependence."

Austen et al. (1987) reviewed the evidence for the efficacy of nicotine chewing gum and concluded that it was very effective in the first three months when used in conjunction with a group or practitioner support scheme. Thereafter, results were not statistically significant although it was felt that they might have clinical significance. Benton et al. (1989) evaluated a hospital based smoking cessation programme which included an initial assessment of the individual followed by six once weekly group meetings. Optional use of nicotine containing chewing gum was chosen by 50% of subjects. Abstinence rates at the end of the six week course varied from 40% to 75% (mean 56%). At three months, abstinence rates varied from 18% to 63% (mean 40%). At six months, abstinence rates varied from 14% to53% (mean 36%). At twelve months, abstinence rates varied from 5% to 47% (mean 32%). 29% of those who chose to use Nicorette were abstinent at one year. It was felt that this intensive clinic approach was appropiate for those highly addictive

54 smokers who acknowledge the harmful health effects of smoking and who wish to quit but cannot do so easily without help. Edmundson et al. (1991) concluded from the cessation literature that the more intensive and extensive strategies are more effective than single strategy or single session methods. Edmudson et al. argued that for the individual smoker, conscientious attendance at a multicomponent, small group cessation progranimme (including nicotine replacement strategies) is the best possible move towards becoming an ex smoker. Such a programme is likely to produce a 30% quit rate at 1 year follow-up which is a good result compared with a single attempt at self quitting or even quitting with the advice and assistance of a primary care physician. Self help efforts have lower quit rates than do clinical interventions, although the differences are not large., Formal cessation clinics have the highest rate of successful long term cessation of any smoking control strategy, but only a limited number of smokers will participate in such programmes.

2.9.5 Suggestions for more effective school based educational strategies and policies

Many researchers have put forward suggestions in an effort to create more effective school programmes in the future. Green and Iverson (1982) point out that there are three main types of factors which influence health behaviour and are modifiable by educational intervention: predisposing factors (knowledge, attitudes, beliefs); enabling factors (skills/resources, for example, communication skills); and reinforcing factors (for example, students are reinforced for skills in declining or resisting the offer of a cigarette). Green and Iverson suggested that "the most effective health education programmes combine learning experiences directed at all three sets of factors influencing behaviour, based on an educational diagnosis of the predominant varaiables in each category". Gritz (1984) argued for the effectiveness of a social psychological approach which teaches social skills and techniques for resisting smoking. This approach would focus on the immediate negative consequences of smoking (both social and physiological); and teach adolescents about peer pressures, adult and family role models; and attempt to inrioculate adolescents against pro-smoking messages in advertising. Gritz suggested that films or peer leaders may be useful in this approach and that life skills training may also be utilized, for example, adolescent developmental issues such as self esteem, self confidence, coping with anxiety or developing autonomy might be addressed. Gritz offers a number of practical recommendations:

(i) Since adolescents are generally well informed about the long range health consequences of smoking, these should only be mentioned briefly. (ii) The immediate physiological consequences should be discussd in some detail so as to highlight the acute effects of smoking on the body. (iii) Alternatives to smoking for promoting desired aspects of self image among teenagers (for example, sophistication, maturity, independence) should be discussed.

55 II

(iv) The increasing social pressure against smoking, both from legislation and informally, should be mentioned. 11 (v) The negative cosmetic effects of smoking should be mentioned. I (vi) The increasing body of evidence that passive smoking is injurious to non- smokers should be discussed. II (iv) The purported social social benefits of smoking should be discussed, with an emphasis on the fact that most adults who took up smoking for those reasons would quit now if they were able. 11 (v) Adolescents should be helped in the development of verbal and behavioural tools for resisting social pressures to smoke. II (vi) Free materials should be made available from voluntary health agencies to distribute individually and place in waiting rooms. I Reid (1985) stated that educational programmes should begin by about age 8-10, with a high priority for the 11-13 age group. These programmes need to be age specific and be based on education for personal growth rather purely information II giving approaches. Schools should have a code of practice regarding smoking on school premises with the aim to be as smokefree as possible (rules for teachers and students alike). Ideally, school based activities should should form a part of wider II community initiatives, for example, encouraging local tobacconists to observe the law regarding selling tobacco to those under age and gaining parent support for school policies. II Brink et al. (1988) argued that smoking education components need to be provided before adolescents begin smoking). and that there are six main components which are important in a smoking prevention programme: II information; skills development; commitment component; learning strategies; peer leaders; booster sessions or follow up programs. Effective smoking cessation programmes might include: a skills focus; teacher leaders; peer leaders who are ex III smokers; a short timeline of three to four weeks; goal setting; small groups to increase social support through a substitute peer group; self assessment as to the type of smoker they are and why they smoke; role play; contracts for cessation and maintenance. II

Hynes (1989) outlines a proposed prevention programme directed at girls 12 to 18 years of age in New York City. This programme consists of five main components: 11 (i) increase knowledge of smokings short and long term health effects; II (ii) increase understanding of the influences on smoking behaviour of peers, family, government regulations, and the news media; U teach social skills and behaviours (for example, assertiveness training through role playing) which could help the adolescent to resist smoking;

(iv) establish and enforce no smoking policies within schools as a first step II toward developing a supportive non smoking environment; II II

56 II (v) orient teachers (appropriate training) in an integrated approach to health in the school. It was suggested that these component be placed within a 12 week school based smoking prevention programme as part of a year long health education or drug education curriculum in junior and senior high schools. In addition, more school wide activities could also be implemented, such as endurance sports events with developing a healthy heart as the emphasis; poster contests with themes such as "smoking stinks"; and letter writing campaigs to governmental bodies in support of stronger anti smoking regulations. Glynn (1989) reported on the conclusions of a National (U.S.) Cancer Institute- convened expert advisory panel charged with addressing: "What are the essential elements of a school based smoking prevention program?". Based on the success or failure of past school based smoking prevention programmes, the panel made a number of recommendations for future programmes:

(1) School-based smoking prevention programmes may have a smoking only or a multicomponent health focus, since both appear to have equal effect on smoking prevention, provided the smoking prevention component receives significant attention (defined as a minimum of five classroom sessions in each of two years).

(ii) Minimum smoking prevention programme components should include information about the social consequences and short term physiological effects of tobacco use; information about social influences on tobacco use, especially peer, parent, and media influences; and training in refusal skills, including modeling and practice of resistance skills. (iii) The minimum length of school based prevention programmes should be two, five session blocks delivered in separate school years between sixth and ninth grade. Sessions may be delivered contiguously or during the course of the school year. A preferred length would be up to 10 smoking focused sessions each year during each of grades six-nine.

(iv) Ideally, tobacco-use prevention programmes should be included in all grades. Where this is not possible, programmes should be focused on grades six-nine, beginning in grades six or seven, whichever of these is the transition year from elementary to middle or junior high school.

(v) Peer involvement in the delivery of school based smoking prevention programmes can enhance programme efficacy. The most effective involvement has been with a peer leader who assists a trained teacher in implementing specific portions of the programme.

(vi) Parental support of school- based - -smoking prevention programmes is important to their effectiveness, and active parental involvement may contribute to programme effectiveness among groups in elementary grades.

57 (vii) Teacher training for the implementation of any smoking prevention programme is essential. The length and content of the training should be modelled as closely as possible on that used in the particular curriculum being adopted. Especially important are the inclusion of experiential activities such as role playing, refusal skills training and interaction with peer assistants, and training in maintaining adherence to the curriculum being used.

(viii) Successful programme implementation must consider: community norms and needs; the interests of the entire educational community, including teachers, principals, parents, administrators, and board members; current school smoking policies; costs; needs of the existing curriculum; and ease of implementation. WHO (1990) argued that an educational programme on tobacco should recognize that children learn at school, at home, and in the community. They make a number of suggestions: (i) school initiatives should start with baseline information and materials; (ii) school curriculum time should be set aside and teachers should be adequately trained to educate youngsters about tobacco; (iii) school programmes should link with the community and involve parents and childrens out of school activities;

(iv) educational measures should be part of an effort to create an environment in which children will find it easy to say no to smoking; (v) education should start well before adolescence and be age-specific. Dusenbury et al. (1992) argued that in interventions with sixth and seventh graders in school settings, the differences between ethnic groups may not be as important as the overall similarities with respect to predictors of smoking. They feel that the interventions most likely to prevent smoking are those that promote peer resistance skills and the motivation to use those skills in all groups But that the potential reception by the target audience might be enhanced, and the efficacy of the intervention maximised, by material which is sensitive to a whole range of cultural orientations.

58 U 2.9.6 Conclusions Rundall and Bruvold (1988) suggested that "Perhaps the long term superiority of school based smoking prevention programmes is in part due to consistent anti-smoking messages in the general media and to the emergence of a strong anti-smoking social movement exemplified by changes in smoking regulations pertaining to restaurants, office buildings, and airplanes. This line of argument emphasises the importance of influences external to a students school environment that may affect the long term outcomes of school based interventions Indeed, Macfarlane (1993) argued that school health education programmes are unlikely to work on their own and suggested therefore that such programmes need to be part of a concerted effort by the government of the country to take responsibility for health promotion through the enactment and enforcement of effective laws (for example, prevention of cigarette sales to minors, cigarette advertising bans). The New Zealand Drug Education Directory For Schools and Sponsors (1992) outlines a number of drug education programmes and resources which are currently available in New Zealand. It also provides information about drug education resource organisations and community organisations. It should be remembered however that youth who have the highest tobacco use rates are usually among those least likely to be reached through school based programmes. Therefore other channels may be needed to reach these high risk youth: parents/family; mass media; marketing/advertising agencies; law enforcement agencies; peer leaders/community leaders; schools (early grades, policy enforcement, instruction, referrals); workplace; unemployment agencies; local/ state/ federal government agencies; drug treatment programmes; boys/girls clubs; youth service bureaus; neighborhood centers; social service agencies; fraternal organizations; church groups; planned parenthood clinics; maternal and child health clinics; physicians/ nurses/ health clinics; native American reservations. (Glynn et al., 1991)

59 2.10 Media campaigns The broader message environments in which people live are important in the initiation, experimentation and maintenance of smoking behaviours (Wallack and Corbett, 1987). The use of mass media can create climates of opinion, present broad messages, and provide an umbrella for more personal educational activities (Farley, 1991). Media campaigns have a number of advantages over other types of public health strategies: (i) mass media presentations can reach a large proportion of the population; (ii) mass media programmes are able to reach groups who are difficult to access through other means; (iii) mass media interventions are relatively inexpensive; (iv) mass media messages can be sophisticated and potentially powerful in a manner not available to other types of interventions (for example, using positive role models such as sporting stars); (v) mass media has the potential to modify the knowledge or attitudes of a large proportion of the community simultaneously, thereby providing social support for behaviour change not available within individually targeted interventions. (Redman et al., 1989) Media campaigns can help to create a milieu in which tobacco use is no longer the norm, thus facilitating change among users and discouraging adolescents from beginning to use tobacco. (Novotny et al., 1992)

2.10.1 Are mass media interventions effective? A British cessation campaign "Smokeout" involving a local radio station in 1982 was evaluated by Naidoo and Platts (1985). Smokeout used two means of communication (radio and post) and ran for four weeks, with each week concentrating on a different stage in the process of giving up smoking as outlined in the Health Education Council Booklet, So you want to stop smoking, thinking about stopping, preparing to stop, stopping, and staying stopped. The radio station broadcast jingles and interviews with experts and a test group of smokers who volunteered to give up with Smokeout. Two disc jockeys also volunteered to give up with Smokeout and promoted the campaign. Listeners were invited to join Smokeout by ringing in to request a postal pack. This pack included the HEC leaflet and badge, plus a special local newspaper - Smokeout News. The initial six month evaluation of a random sample of 100 participants found that the postal pack was more memorable than the radiO programmes. The 21% smoking cessation rate after six months was comparable to the rates achieved by other more intensive group methods of smoking cessation. The smoking cessation rate of 16% after 11 months was very satisfactory and indicated that a mass media campaign was an economic option.

zo Bird et al. (1986) evaluated the impact of The Great New Zealand Smokefree Week on the smoking behaviour of third and fourth form Wellington students. Activities undertaken during the week included: extensive media promotion; smoker adoption programmes with kits available from chemists; promotional material including posters, stickers, deck signs, t-shirts; and local events such as a fun run, smoke free areas in restaurants and a debate. Schools were sent educational and promotional materials, and were encouraged to promote the week within the school. Bird et al. found a high level of awareness of the campaign which was promoted most successfully by the promotional materials, television, and smoker kits. They also found that the campaign had had positive effects on the smoking behaviour of adolescents, for example, a highly significant reduction in smoking occurred in the period during which the campaign took place (net reduction of 27% of smokers) and a highly significant number of fourth form girls gave up (net quitting of 30% of smokers). It was concluded that the campaign had been at least somewhat successful and should be repeated. Flay (1987) found that media viewing plus a social support condition was the most effective mass media condition in the study. Redman et al. (1989) reviewed 24 evaluations of the effectiveness of mass media programmes in modifying cardiovascular risk behaviour or safety restraint use among adults. When media-alone interventions designed to alter behaviour directly were evaluated, they were found to have little impact on behaviour. On the other hand, when the media had been used in an agenda-setting role in combination with a community component, significant changes in behaviour were reported. Redman et al. argued however that there was no evidence at that time to support the view that the media component makes a contribution to the effectiveness of such combined programmes. Pierce (1990) concluded after reviewing past research that there was good evidence to support the view that counteradvertising (anti-smoking) does have a significant influence on children and that therefore these campaigns should continue. Bauman et al. (1991) evaluated the influence of three mass media campaigns on variables related to adolescent cigarettes smoking. The three campaigns were: (i) The first campaign consisted of eight 30-second radio messages that focused on seven expected consequences of smoking that are related to whether adolescents become regular smokers.

(ii) The second campaign was similar to the first but also included a 60-second radio message that invited persons 12 to 15 years old to enter the "I wont smoke sweepstakes". Entrants were mailed a brochure that asked them to talk to their friends about not smoking, to encourage their friends to pledge not to smoke, and to have their friends enter the sweepstakes. A $20 incentive was offered for recruiting five or more entrants. The brochure was also mailed to the friends they recruited.

(iii) The third campaign was similar to the second but included a television broadcast of the sweepstakes offer and only three of the expected consequences messages.

61 Results indicated that the subjective expected utility of smoking and friend approval of smoking was influenced by the media campaigns. The less costly radio only campaign was as effective for these variables as any of the more expensive campaigns. It was felt however that any potential effect for smoking still remains to be demonstrated as no effect for reducing the onset of smoking was detected. Bauman et al. argued that their results supported radio as having potential for health promotion among adolescents. I WHO (1990) argued that publicity and information campaigns can be effective in motivating smokers to try to stop. They cite one example where British participants said that their annual no-smoking day costs as little as U.S. $270,000 to organize and may encourage up to 50,000 smokers to give up permanently. It has been suggested (Burns, 1991) that the chanes in cigarette consumption during this century in the U.S. can be related to media information campaigns, for example, a substantial downturn in consumption coincided with the lay medias presentation of scientific evidence establishing the risks of smoking in the mid 1950s. A major downturn in per capita cigarette consumption also occurred during the late 1960s; between 1967 and 1970, mandated antitobacco spots were shown on television to counter cigarette advertisements. When cigarette advertisements were banned from television in 1970, the bulk of the anti tobacco advertising campaign also disappeared, and per capita cigarette consumption again increased. Burns does state however, "that these informational campaigns of themselves were unable to create and sustain cessation in the majority of smokers. Edmundson et al. (1991) looked at the results of the U.S. public health campaigns conducted from 1967 to 1970 and concluded that these results suggested that sustained counteradvertising did affect the smoking related beliefs and behaviours of many cigarettes smokers. The results also suggested a dose-response relationship: as counteradvertising was increased and maintained, smoking prevalence decreased.

2.10.2 Future media campaigns Syme and Alcalay (1982) argued that media models of smoking should be changed from positive, heroic associations to negative, nonheroic portraits; and that there should be persistent repetition on various media showing correlations between smoking and diseases. WHO (1990) suggested that novel ways must be found to present information. They cite Richard Petos calculation on British male smokers:

"Out of every 1000 young males who smoke at least a pack of cigarettes a day: one will later be murdered; six will die in a traffic accident; 250 will die before their time from the effects of smoking" It was suggested that presentations of local statistics are more effective than presentations of national statistics. Cotton (1990) reported on a number of American campaigns which have found such tactics as ridiculing different brand names (for example, "Bariboro" and "Wimpston") or providing alternative sporting /cultural events (for example, the

62 Emphysema Slims instead of the Virginia Slims Womens Tennis tournament) to be useful. Flay and Burton (1988) suggested that there are six necessary and interrelated conditions for an effective campaign:

(1) The campaign should include high quality messages, information sources, and media channels.

(2) The message must be disseminated to the target audience and presented frequently, with some variety, over a long duration and at optimal viewing times.

(3) The campaign must retain the audiences attention by ensuring the quality of the message, providing app ropiate and supportive media channels, and ensuring that the message corresponds to audience characteristics.

(4) Interpersonal communication among members of the target audience should be encouraged. Groups with opposing views should be encouraged to exchange dialogue that might influence social norms.

(5) The campaign should facilitate changes in individuals in the target audience. For example, dialogue between smokers and non smokers could enhance smokers awareness of their behaviours undesirable effects on others.

(6) The campaign should influence social norms against smoking. Social norms might also be influenced by dialogue between legislators and their constituents; voter support of an increase in the excise tax might be one example ".

Cummings et al. (1991) stated that "the mass media play a critical role in influencing what society knows, believes, and does with respect to tobacco use". Therefore we must increase the publics exposure to pro-health antitobacco messages by the use of such tactics as: counteradvertising; public relations events (for example, Great American Smokeout or tobacco awareness weeks); and advocacy, that is, using the media to promote public debate about the tobacco issue.

Edmundson et ad. (1991) suggested that mass media campaigns need to provide smokers with requisite skills to quit smoking and to provide non smokers with the skills needed to remain abstinent. For example, television may be used as a popular medium for demonstration programmes in which celebrities or trained individuals serve as role models and provide specific instructions and demonstrate skills that the audience is encouraged to emulate (that is, televised. Since the targeting of women by tobacco advertising has been associated with a dramatic rise in the number of women who smoke and who develop smoking related disease, Thompson et ad. (1991) suggested a number of channels through which to reach women. For example, womens magazines stopping accepting tobacco advertising and instead presenting articles about health risks etc; the health care system, for example, ante natal clinics; supermarkets and food stores. Thompson et al. also suggested that three messages which may be particularly important in targeting women are: smoking is as much a health risk for women as

63 for men; quitting smoking promotes the health of children; the possibility of being slimmer is not important enough to risk the health dangers of smoking.

2.10.3 Conclusions A number of activities/promotions have already been conducted in recent years in New Zealand in an effort to promote a Smokefree environment. Many of these promotions have been used to achieve media coverage for smokefree issues. The aim of these promotions has been to establish being smokefree as cool and have used music, dance, drama, and sport as the vehicles for smokefree messages (Smokefree activity, 1991 H). Examples of activities conducted by the Canterbury Area Health Board include: (i) Mrs Popes nappy pamphlet promotion (Smokefree Activity, 1991 A). (ii) World no tobacco day promotion (Smokefree Activity, 1991 B). (iii) Smokefree "know your rights" pamphlet (Smokefree activity, 1991 C). (iv) CHCH Womens hospital ante natal clinic display (Smokefree activity, 1991 E). (v) Smokefree sports launch (Smokefree activity, 1991 F). (vi) Smokefree schools sportsdraw booklet (Smokefree activity, 1991 J). (vii) Smoking cessation pamphlet "ready set quit" (Smokefree Activity, 19911).

64 2.11 Restricting access to tobacco One solution to the problem of adolescent smoking is to restrict childrens access to cigarettes thereby reducing consumption of the product and, ultimately, damage to health. Easy access to tobacco is a prerequisite to maintaining a tobacco addiction. If minors have difficulty in obtaining tobacco, they may be prevented from experimenting with and later becoming addicted to it (Altman et al., 1989; Davis, 1991). The discrepancy between what children are taught in school (not to smoke) and what they observe and experience outside of the classroom (for example, a willingness on the part of merchants to sell them tobacco) must be removed. Community norms and merchant practices regarding sales to adolescents must be changed. (Altman et al., 1991) Skretny et al. (1990) cite an example from their study where a clerk stated "its terrible that you are buying cigarettes. It is wrong, but I guess you could be doing worse things". This is especially true in the case of tobacconists selling single cigarettes to adolescents. Amos (1990) points out that many children cannot afford to buy whole packets of cigarettes, hence

"in effect shops sell them a dose of the drug they can afford until they are addicted. Then, when they can spend more, they will graduate to a larger, more regular dose. If this were cocaine or glue for sniffing, government action would be swift and decisive. Instead a drug that will eventually kill 100,000 of todays 11-15 year olds does not seem to matter" WHO (1990) argued that tobacco sales to minors both through direct sales and through vending machines should be banned. In many countries, including New Zealand, such legislation is already in place, but enforcement is another matter. For example, the U.S. Centers for Disease Control (1990 A) reported on the findings of the Office of Inspector General (IG), U.S. Department of Health and Human Services who evaluated in 1990 the enforcement of laws restricting minors access to tobacco. The IG found minimal enforcement of the laws, for example, in 1989 only 32 vendor violations were cited, even though an estimated one billion cigarette packs are sold each year in the U.S. to individuals under the age of 18. In South Australia there has been less than one prosecution per year since 1986 for the offence of selling tobacco to a minor, although surveys during the same period found that over one-third of adolescents aged 15 were regular smokers (Woodward et al. 1989).

And in New Zealand despite the Smoke-free Environments Act which forbids the sale of cigarettes to those under 16, Weir (1992) reported that this Act is constantly breached since prosecution is very difficult as it is a defence if the seller "believed the person was over 16". There is also no requirement that the seller ask for proof of age. Weir also reported that there is evidence of single cigarettes in dairies close to schools. Kim (1987) points to a lack of knowledge about the legislation and/or a lack of enforcement of the legislation as being major barriers to the prevention of tobacco being obtained by adolescents. Kim also points out that there seems to be little or no social ethic that says adolescents should not be sold tobacco if they want it. Novotny et al. (1992) stated that vendor compliance with such laws wi11 not ensure behaviour changes among adolescents, but the community non smoking norm will be supported through visible enforcement of these lawstt.

2.11.1 How easily can minors obtain tobacco? Numerous studies have demonstrated the great ease with which adolescents can obtain tobacco despite legislation being in place to prevent them from doing so. Such studies have been conducted in two main ways: direct estimates and self- report estimates.

2.11.1.1 Direct estimates The usual scenario in a direct estimate is for a minor to enter each establishment unaccompanied, look for a posting of the law, and either request cigarettes from the cashier or from a vending machine. It is usual for the chosen individual to look their age and no attempt is made to make the individual look any older. DiFranza et al. (1987) evaluated the efficacy of a Massachusetts law prohibiting the sale of tobacco to individuals under the age of 18 through the cooperation of an 11 year old girl. She was successful in 75 of 100 attempts to purchase cigarettes and only 4 of the 100 stores sampled had a copy of the law posted where it was visible to customers. When contacted by phone, 64% knew of the law, while 36% either were unaware of the law or could not correctly identify the legal age for purchasing cigarettes. Of those establishments who did know the law, 73% had sold cigarettes to the child; and of those establishments that did not know the law, 86% had sold cigarettes to the child. The availability of tobacco products to minors in Witchita, Kansas was studied by Hoppock and Houston (1990) through the use of two minors (aged 12 and 15 years) who visited retail stores and vending machines. Overall the study found lower purchase rates than those previously found in Massachusetts, California, Illinois, Manitoba, and Great Britain. Minors were able to purchase tobacco in 34% of attempts, compared with 63% to 91% purchase rates in other studies. It was suggested that this may be due to more conservative and less tolerant attitudes in Kansas and/or due to changes in the social acceptability of smoking in America. Despite these differences it is important to note that minors were able to purchase tobacco in one third of attempts, and when not able to purchase, they only had to travel a short distance to another retail store or a vending machines which were found to be universally accessible. In two occasions where a clerk refused to sell a minor a tobacco product, they were specifically referred to a cigarette vending machine by the same clerk. Therefore tobacco laws are only variably effective or not adequately enforced. In an Oregon study conducted by Thomson and Toffler (1990), teenagers were successful 88% of the time in illegally obtaining cigarettes over the counter and were successful in obtaining cigarettes from vending machines 100% of the time. The U.S. Centers for Disease Control (1990 C) reported on a study which evaluated the effectiveness of the Colarado legislation enacted in 1987 which prohibited the sale of tobacco to persons under the age of 18 years. Adolescents (aged between 9-17 years) attempted to purchase tobacco in a number of retail

Me outlets, Of 121 purchase attempts, 97 involved contact wih a vendor and 24 involved vending machines. Overall, 64% of attempts were successful (55% of the vendor contacts, 100% of the vending attempts). The success rate was similar for those older than 14 and those 14 or younger. Girls were more successful than boys (60% versus 48%) but this difference was not statistically significant. Attempts were more successful in pharmacies and gas stations than in food stores and convenience stores; attempts at nonfood outlets were more likely to be successful than attempts at food outlets. Purchase attempts were more successful in rural towns than in suburban stores. For 71% of the vending machines, the required warning signs were not posted. Jason et al. (1992) observed minors attempting to purchase cigarettes from vending machines in Chicago at a bowling alley, a shopping mall, and a restaurant. During 14.5 hours, 14 minors were observed attempting to purchase cigarettes from these machines with a success rate of 100%. In a second study, Jason et al. recruited 20 minors (average age 13) who attempted to purchase cigarettes in four different locations (supermarkets, gas stations, pharmacies, convenience stores). The percentage of merchants selling cigarettes to a minor was 80% in 1988 and 82% in 1989. In an Australian study (Sanson-Fisher et al., 1992), two minors who looked young for their age attempted to purchase cigarettes from 101 different retail outlets. No challenge about age was made for 70% of purchases, and proof of age was requested on only 15% of occasions.

2.11.1.2 Self-report estimates Self-report estimates are another way of assessing where adolescents obtain their cigarettes. Stanwick et al. (1987) found that in 1985 the majority of Manitoba (Canada) public school children (8-15 years of age) who smoked regularly (defined as usually everyday) reported obtaining their cigarettes from stores despite it being illegal for merchants to sell cigarettes to anyone under 16 years of age. They suggested that if there was effective enforcement of this law (not a single prosecution in over 45 years), authorities would profit from almost a million dollars in cigarette sales from Manitoba alone and have an impact on the leading cause of preventable death and disability. Forster et al. (1989) report the results of a survey of 15-16 year olds in two Minnesota cities. Teenagers were found to perceive easy access to cigarettes and reported purchasing cigarettes in a variety of locations, but particularly from gas stations, convenience stores, and vending machines. Few reported obtaining cigarettes from parents or other adults. The majority were able to state the legal age of sale of cigarettes in Minnesota but few reported ever being asked for proof of age when attempting to purchase cigarettes. In 1989, the Teenage Attitudes and Practices Survey (TAPS) collected information (by telephone or mail) from a national household sample of U.S. adolescents (12- 17 years of age) (U.S. Centers for Disease Control, 1992). Of the current smokers in this group, approximately 57.5% usually bought their own cigarettes. Smokers aged 16-17 years were more likely to have bought their own cigarettes (66.6%) than were smokers aged 12-15 years (45.3%). Of those who usually bought their own cigarettes, an estimated 84.5% often or sometimes purchased their cigarettes

67 from a small store, approximately 49.5% purchased cigarettes often or sometimes from a large store, and about 14.5% purchased cigarettes often or sometimes purchased cigarettes from a vending machine. Of those who had not smoked a cigarette, 62.4% believed it would be easy for them to obtain cigarettes. Jason et al. (1992) interviewed 24 adolescent smokers (<18 years) at various Chicago establishments. The frequency adolescents reported they purchased cigarettes ranged from once a week to daily. When asked how often they were refused cigarettes out of 10 attempted purchases, only one minor said that merchants refused to sell her cigarettes on occasion. In an Australian study, Sanson-Fisher et al. (1992) surveyed 1,849 12-15-year-old adolescents about their ability to purchase cigarettes from retail outlets, 38% reported having purchased cigarettes illegally. When McLeod et al. (1991) asked form 1 and 2 Nelson students where they got their cigarettes from, 10.5% stated that they had bought them from shop despite this being illegal. 44% had got the cigarettes from their friends, 23% from their parents, 23% from other, 12.8% from brothers or sisters, 9.2% got someone else to buy them, 7.1% stated from cousins.

2.11.2 Interventions to increase the effectiveness of legislation In a British study (Naidoo and Platts, 1985), four volunteer children well under 16 years of age visited 100 randomly selected tobacconists and attempted to buy a pack of cigarettes. A few days later, the tobacconists were visited and interviewed about their knowledge of the relevant law, and their attitudes and policies towards the selling of cigarettes to children. Of the 100 tobacconists, 91 sold the child cigarettes. Sixteen indicated that they knew their action was illegal by putting the cigarettes in a paper bag, telling the child to put them in their pocket, or remarking that they shouldnt really be selling them. All the sales people knew there was a law restricting the sale of cigarettes to children but there was some confusion over legal age limits, and whether it was the shopkeeper or the child who was guilty of the offence. These results were then released at a press conference and a letter was sent to all tobacconists which aimed to dispel confusion. Later on a replication of the study was made to evaluate the efficacy of the letter etc. 56% of the shops refused to sell cigarettes to the child. Of those who did sell, half asked the child who the cigarettes were for. 76% of the shops were displaying signs stating the relevant law and 96% of the salespeople could state the relevant law correctly. In a study by Altman et al. (1989), 412 stores and 30 vending machines were visited by 18 minors aged 14 through 16 years with the intent to purchase cigarettes. They were successful at 74% of the stores and 100% of vending machines. After an aggressive six month campaign using 1) community wide media, 2) direct merchant education, 3) contact with the chief executive officers of chain stores and franchise operations owned by major companies, the percentage of stores with illegal over- the-counter sale of cigarettes was reduced to 39%. Sales from vending machines were not reduced. There was an increase in the posting of warning signs and an increase in the frequency of minors being asked their age. Therefore it is argued that an aggressive merchant education programme combined with community organizations applying pressure on merchants to change their practices and a broad based media campaign can reduce illegal over-the-counter cigarette sales.

.1 - Altman et al. (1991) reported on a one year follow up of the above study (Altman et at, 1989). Statistically significant reductions from pre test to post test in over- the-counter sales to minors at the one year follow up were found despite sales increasing between pre and post test. Altman et al. felt that a comprehensive merchant community and education campaign can achieve sustained effects in reducing sales of cigarettes to minors, but that without continued intervention, monitoring, and sanctions, recidivism will occur. Skretny et al. (1990) evaluated the efficacy of an intervention to stop the illegal sale of cigarettes to minors. 62 of 120 stores in Erie County, New York, were randomly selected to receive in the mail an informational packet requesting their help in stopping the illegal sale of tobacco to minors. The packet include a letter to the store manager citing the law prohibiting the sale of tobacco products to minors and requesting their assistance in observing the law; a supply of warning signs; and a tip sheet designed to assist store managers in educating their employees about the law. Two weeks after the mailing, stores in the study were visited by adolescents aged 14 to 16 years who attempted to purchase cigarettes. The intervention resulted in an increased number of stores posting warning signs, but had no effect on deterring the sale of cigarettes to minors. Minors purchased cigarettes in 77% of sores that received the special mailing and in 86% of non- intervention stores. Warning signs were visible in 40% of stores that received the special mailing and in none of the non-intervention stores. Skretny et al. felt that findings from their study suggested that a merchant education programme to increase awareness of the law and posting of warning signs is not sufficient to discourage the sale of tobacco products to minors. Jason et al. (1991) assessed the effect that cigarette legislation would have on reducing merchant sales of cigarettes to minors and the effect on adolescent smokng behaviour in Woodridge, ill. Cigarette sales to minors were successfully reduced to a minimal level (from 70% to 5% in 1.5 years of compliance checking) as a result of legislation. And rates of cigarette experimentation and regular use of cigarettes by adolescents were reduced by over 50%. Jason et al. felt that the legislation was effective in Woodridge because (i) police conducted regularly scheduled compliance checks and used uniform checking methods, (ii) legislation was coupled with a strong educational message fromthe police to community members at the beginning and end of every school year, and (iii) the communitys success received consistent media exposure. The efficacy of the Tobacco Institutes "Its the Law" programme which had the goal of eliminating the illegal sale of tobacco to minors through the distribution of signs, decals, buttons, employee certification brochures, and other literature, was evaluated by Difranza and Brown (1992). Only 4.5% (7) of the 156 retailers surveyed were participating in the Tobacco Industrys programme. Six of the Seven participating retailers (86%) were willing to illegally sell cigarettes to children; 88% of the retailers who were not participating in the programme were willing to sell cigarettes to children. State mandated warning signs were displayed by 61 retailers, of whom 80% were willing to illegally sell tobacco to children. Forster et al. (1992) evaluated the efficacy of a policy which required that vending machines be fitted with electronic locking devices. The rate of non compliance by merchants was 34% after 3 months and 30% after 1 year. The effect of the law was to reduce the ability of a minor to purchase cigarettes from locations originally selling cigarettes through vending machines from 86% at baseline to 36% at 3 II months and 48% at 1 year. Forster et al. suggested that an outright ban on vending machines would be even more effective since compliance is a problem. A 2.11.3 Suggestions for ways to make future legislation more effective I A number of suggestions have been made which aim at increasng compliance to legislation: I (i) Possession of tobacco by children should be prohibited. (DiFranza et al., 1987) I (ii) Possession or use of tobacco by students should be specifically prohibited on school property. Smoking by school personnel should also be banned to prevent them from acting as role models (DiFranza et al., 1987). II (iii) The sale of all tobacco products to individuals under the age of 18 (Choi et al., 1992) or 19 (U.S. Centers for Disease Control, 1990 A) or 21 years (DiFranza et al., 1987; Skretny et al., 1990) should be prohibited (and II standard age identification required for sale) (DiFranza et al., 1987; Stanwick et al., 1987). II (iv) Signs warning that it is illegal for minors to buy tobacco, or for stores to sell it to them, should be conspicuously visible to both employees and customers (DiFranza et al., 1987; Stanwick et al., 1987; Altman et al., 1989; Choi et al., I 1992).

(v) State law should require schools to provide education about the effects of II tobacco use (DiFranza et al., 1987; Stanwick et al., 1987).

(vi) Cigarette vending machines should be prohibited. (DiFranza et al., 1987; 11 Altman et al., 1989; Hoppock and Houston, 1990; U.S. Centers for Disease Control, 1990 A; Choi et al., 1992). Or vending machines could carry a warning and be licensed (Stanwick et al., 1987). Or have an electronic II disabling system (Hoppock and Houston, 1990).

(vii) All free distributions of tobacco should be prohibited (DiFrauza et al., II 1987; Choi et al., 1992).

(viii) All vendors of tobacco products should be licensed annually with the threat UI of fines or loss of licence if the law is not complied with. (DiFrauza et al., 1987; Stanwick et al., 1987; Altman et al., 1989; Skretny et al., 1990; U.S. Centers for Disease Control, 1990 A; Choi et al., 1992) II

(ix) Penalties for the sale of tobacco to minors should be consistent and stringent enough to deter would be offenders (DiFranza et al., 1987; Altman et al., 1989; Hoppock and Houston, 1990; Skretny et al., 1990). For example, use of fines (Altman et al., 1989); graduated schedule of penalties for illegal sales to minors and separate penalties for failure to post warning U signs about the illegality of sales to minors (U.S. Centers for Disease Control, 1990 A); reliance primarily on civil penalties rather than on the U U 70 U court system to punish offenders (U.S. Centers for Disease Control, 1990 A). Suggestions for compliance checks include: provision of a bounty (a portion of any fine against a merchant caught selling tobacco to a minor goes to the informer who notified the authorities) or the use of a minor topurchase tobacco for the purpose of monitoring compliance (DiFranza et al., 1987). DiFranza et al. (1987) suggested that voluntary health organizations, parent-teacher associations, and youth groups could earn money while helping to enforce the law. Money obtained from penalties could also be used to support community health projects such as smoking cessation programs or school health education.

(x) Vendors must be educated about tobacco laws (for example, posting of the law in the shop) if cooperation and compliance is to be achieved (DiFranza et al., 1987; Hoppock and Houston., 1990; Skretny et al., 1990).

(xi) A national campiagn should be mounted to inform parents, health professionals, community organizations, and the business community about the problems and provide them with the resources to deal with it (Altman et al., 1989; Hoppock and Houston, 1990; Skretny et al., 1990).

2.11.4 Conclusions Altman et al. (1991) argued that it is important to combine education of merchants and the public with the "bite" of enforcement. It is suggested that communities will respond more favourably to enforcement measures if educational interventions are implemented first.

One radical suggestion (The Press, Wednesday, 24/03/93) made by Dr Stephen Juan (Head of Sydney Universitys early child development centre) is that cigarette smokers should be treated as addicts and forced to buy their cigarettes from chemists. "I think they (cigarettes) should be sold out of chemist shops with addicts being registered. The addict would have to go to the doctor. It would be treated as an addiction because that is what it is. This would block children access to cigarettes and give all smokers counselling on how to quit".

71 2.12 Taxation of tobacco Since most adolescents have minimal purchasing power, it has been argued that increasing taxation on tobacco may be an effective way of combating teenage smoking (Novotny et at, 1992).

2.12.1 The higher the taxation, the lower the tobacco consumption A number of researchers have found evidence to support the view that if taxation on tobacco is increased, then consumption decreases (Roper, 1991). Price has been found to be an important motivating force in the New Zealand market with the impact of punative levels of taxation having far more of a depressing effect on the market than advertising bans or other government restrictions (McLoughlin, 1990). When trends in New Zealand were examined it was found that from 1973-1984, the price of a packet of 20 cigarettes remained relatively stable in real terms and cigarette consumption changed very little. But when there was a sharp rise in cigarette prices in the 1980s, there was a substantial drop in the consumption of cigarettes. And between 1981 and 1991, cigarette consumption fell from 2,666 cigarettes per person per year to 1,541 cigarettes per person per year. (Department of Health/ Department of Statistics, 1992) Laugesen and Meads (1988) also found that in New Zealand, an increase in the real price of cigarettes lowers demand whereas an increase in real disposable income increases cigarette demand. They concluded that price appears to be the most powerful variable which governments can influence. They estimate that when the price rises 10%, sales fall by 4%, other factors being equal. Laugesen and Meads (1991) analysed data from 22 OECD countries over 27 years and found that lower consumption levels were associated with higher real tobacco prices. Higher levels of consumption were associated with higher per capita real income and with a larger fraction of tobacco consumed as manufactured cigarettes. It was stated that tobacco consumption is more responsive to price than to a comparable increase in advertising restrictions. However, price effects can be short lived if eneral price inflation is eroding the relative price of tobacco or if income growth is increasing demand. Laugesen and Meads argued that consumption is three times more responsive to price rises (if indexed regularly for inflation) than to advertising restrictions. This inverse relationship between taxation and consumption has been found to be especially true for adolescents. Therefore increasing the price of cigarettes may be a potent means of reducing the number of adolescent smokers (Wallack and Corbett, 1987; Roper, 1991; WHO, 19??). Wallack and Corbett (1987) suggested on the basis of past research that smoking by youths and young adults is far more responsive to price than is adult smoking. Simons-Morton and Simons-Morton (1988) also found that higher costs for alcoholic beverages reduce consumption, especially among adolescents. A report from the U.S. General Accounting Office (1990) argued that there is evidence to suggested that substantially fewer teenagers smoke when cigarette

72 prices increase, although the extent of this reduction is uncertain. The U.S. Generals Accounting Office estimated (for the U.S.) that given a 21-cents-per- pack increase in the excise tax, the number of teenage smokers would likely decline by over 500,000 which in turn would imply an estimate of over 125,000 fewer preventable deaths.

2.12.2 Taxation as part of a multiple intervention strategy Novotny et al. (1992) reported on research which suggested that changes in excise tax over time appear to be more closely correlated longitudinally with changes in tobacco consumption than the enactment of clean-indoor-air legislation. Novotny et al. also reported on findings from California where voters in 1988 passed proposition 99, which increased the state excise tax on cigarettes from 10 to 35 cents per package of 20 cigarettes; one fifth of the revenues from this tax initiative were directed to tobacco related public education (more than $100 million per year). The imposition of a 25 cent per pack tax increase, combined with a large intervention programme, was associated with a sharp (15%) decline in tobacco sales in California. Preliminary evaluation data on consumption and cigarette smoking prevalence indicate that there may be 750,000 fewer smokers in California since the application of the tax and education campaign. The prevalence of smoking declined to 21.2% in 1990 (following the tax increase and institution of the educational campaign) from a 1987 baseline of 26.3%. Six months after the campaign began, preliminary results from the California media campaign evaluation showed that the awareness of the campaign was 86.9% among in-school youths and 78.3% among adults. The proportion of adults who think about quitting increased from 38.6% to 41.8%, and the proportion of nonsmoking youths who think about starting decreased from 24.6% to 21.4% during this period. Additional evaluations of the effect of cigarette excise taxes have shown that these policies discourage smoking, particularly among teenagers. On a state basis, cigarette excise taxes have contributed to significant changes in consumption. Between 1955 and 1988, enactment of state cigarette tax increases were assoiated with an average 3% greater decline in state cigarette sales than in years without tax increases. Novotny et al. argued that the health benefits of an increase in cigarette taxes are substantial.

2.12.3 Other taxation strategies

An interesting variation on the taxation issue is the proposal by Glantz (1993) that to remove tobacco companies incentives to sell cigarettes to minors, they should be taxed on the profits made from tobacco sales to minors. Glantz proposes that tobacco companies should be charged a total of $US 3.4 billion which is double the profit they make from the sale of cigarettes to minors. Each companies tax would be based on survey results indicating how many packs they sell to minors.

73 2.12.4 Killing the golden goose? Breslow in 1982 argued that in the United States, the government loses much more, for example, through increased health costs because of cigarette smoking, than it recovers from it in taxation. Hence the argument that increasing taxation on tobacco is "killing the goose who lays the golden eggs" is patently not true. Raftery in 1989 also argued that early and naive suggestions that the state in the United Kingdom was reliant on tobacco taxation have been shown to be unfounded. Raftery reported on research which predicted that "a 10% rise in taxation of tobacco in the U.K. would simultaneously reduce consumption by about 6% and would boost revenue by the same amount".

2.12.5 Conclusions Therefore it can be seen clearly that taxation may be a very effective way of helping to combat teenage smoking. It is important to remember that if increased taxes on cigarettes are to be effective, these taxes must maintain real value, that is, 25 cents/pack in 1987 will not be the same as 25 cents/pack in 1993.

74 I I 2.13 Banning cigarette advertising In the U.S. alone, about $3.3 billion is spent yearly on cigarette advertising - cigarettes are the second most common subject of advertising m magazines and the most common in the outdoor media (mostly billboards). (Novotny et al., 1992) Since before the war, cigarettes have been widely advertised in New Zealand. Themes reflected the concerns of their times - wartime advertisements often had a patriotic flavour, and included references to men going off to war, flags and badges. Advertisements aimed at women began to be seen in the 1940s, for example, one had an outline of a womens face with the words: "Personally, I think ones cigarettes are just as important as ones makeup ... and need just as careful choice. Thats why I always smoke Ardath, and their superior tips are a joy to your lips", (Delany, 1988) Advertisement on the cinema and radio also used to be very common. For example, at intermission in the pictures you were told that "it was time for a Matinee" and in the 1960s there was extensive use of free samples. Today advertising in New Zealand is much less blatant and subject to greater restricions. Hence the tobacco industry has moved its emphasis to sponsorship, (Delany, 1998). In recent years, many researchers have called for the banning of all forms of cigarette advertising, especially that which targets women, minorities, the poor, and the young (Reid, 1985; Chetwynd et al., 1988; Carr-Gregg and Gray, 1989; Armstrong et al., 1990; Cotton, 1990: Pierce, 1990; Roper, 1991; Vickers, 1992; WHO, 1990). The tobacco industry continues to claim that advertising, including the sponsorship of sporting and cultural events only affects market share, that is, what brand you choose to smoke, and does not influence children to start smoking or adults to smoke more (The Tobacco Institute of New Zealand, 1991; Vickers, 1992). The tobacco industry have also suggested that bans would unjustifiably curtail commercial freedom; and that if selling a product is legal, then advertising the product must also be legal (Vickers, 1992). It has been argued that the credibility of government health education campaigns is being undermined by the tobacco industry. Through advertising tobacco companies buy the silence of those media who should be actively pointing out the negative consequences for smoking (Breslow, 1982). Carr-Gregg and Gray (1989) suggested that many magazines and newspapers do not wish to offend tobacco advertisers by printing information/articles about smoking health risks and that through the sponsorship of sports and cultural events, the tobacco industry has made it difficult for legislative bodies to move against the industry. Carr-Gregg and Gray point to a British government survey in 1983 which found that 44% of smokers agreed with the statement smoking cant be bad for you, otherwise the government would ban cigarette advertising. Warner et al. (1992) analysed a sample of 99 U.S. magazines during 25 years and found strong statistical evidence that cigarette advertising in magazines is associated with diminishin coverage of the hazards of smoking. This finding was particularly true for magazines directed to women. These findings lend support for the idea that magazines which rely on revenues from cigarette advertising are less

75 likely to publish articles on the dangers of smoking for fear of offending cigarette manufacturers.

2.13.1 Tobacco advertising - market share or total sales Does tobacco advertising simply affect market share or does it work to increase total sales by encouraging adolescents to take up smoking and encouraging those already addicted to smoke more? This is very difficult to evaluate sin companies are unwilling to provide the data on sales and advertising expenditures by brand which could be used to compile a full data set (Raftery, 1989).

2.13.1.1 Evidence to support the total sales argument A number of studies have provided evidence to support the view that tobacco advertising does increase total sales by encouraging non smokers, especially adolescents to take up smoking. In a New Zealand study by Chetwynd et al. (1988), the impact of cigarette advertising on aggregate demand for cigarettes was assessed over the period 1973 to 1985. Findings by Chetwynd et al. supported the proposal that bans on cigarette advertising would result in a reduction in overall cigarette consumption. Their findings suggested that the effect of cigarette advertising does extend beyond merely reinforcing brand loyalty, it affects total industry sales. These conclusions have however been criticised by Jackson and Ekelund (1989) who argued that the Chetwynd et als study is flawed with conceptual and econometric problems. In a reply to these claims, Harrison et al. (1989) found that the model used by Chetwynd et al (1988) performed well against all of a comprehensive battery of econometric testing precedures which went beyond those suggested by Jackson and Ekelund. Again, Boddewyn in 1989 also criticized the Chetwynd et al.s (1988) study on the grounds of inadequate theorization, questionable modelling and operationalization, and the ignoring of contradictory data. However, Chetwynd et al. (1989) argued that many of his concerns are unfounded or have been addressed in subsequent work. They do state however that their analysis could have been improved by a fuller data set and appealed to the tobacco industry to open their data for independent analysis. In 1989, the Toxic Substances Board in New Zealand reviewed all the available evidence as to whether tobacco advertising increases total sales to tobacco or merely affects market share of advertised brands. The Board found that advertising does increase total cigarette sales and that there is a relationship between legislation banning tobacco promotion and reduced uptake of smoking by young people. After reviewing evidence from countries that had banned tobacco advertising on some level, the Board concluded that: (i) bans on tobacco promotion are associated with a lowering of tobacco consumption; (ii) bans on tobacco promotion are effective when part of a total health policy package aimed at lowering tobacco production. On the basis of past research, Pierce (1990) concluded that there is enough evidence to justify "a conclusion of probable causation for the effect of advertising on the uptake of smoking by children".

76 Laugesen and Meads (1991) analysed data from 22 OECD countries over 27 years and found evidence to contradict the tobacco industries argument that advertising bans do not work, or that any effect of such restrictions on consumption is very small. Laugesen and Meads found that tobacco advertising restrictions have since 1973 increasingly been associated with lower tobacco consumption. It was also suggested that advertising restrictions can have enhanced effects over time. Therefore Laugesen and Meads argued that tobacco advertising legislation, once in place, may foster social climate changes increasingly unfavourable to tobacco consumption. This data has however been criticised (Sterling, 1990; Mullins, 1991; Stewart, 1992) and should therefore be considered with caution. In support of a ban on cigarette advertising, Vickers (1992) cites a report by the British Department of Healths economic advisors on the effect of advertising bans in other countries. This report concluded that evidence from other countries (including New Zealand) have shown that cigarette advertising bans have led to significant falls in consumption, for example, in Norway, smoking prevalence among 13 to 15 year olds fell from 17% in 1975 to 10 % in 1990. An article in ASH (1992 A) stated that two tobacco companies dominate the New Zealand market - Rothmans (80%) and W.D. & H.O. Willis (20%). Despite arguments that advertising only changes brand choice, it seems that these two companies produce some 25 brand names (for example, Rothmans is the parent of Winfield, Pall Mall, Rothmans, and John Brandon), so the chances are if a smoker changes brands - they may not be changing manufacturer.

2.13.1.2 Evidence to support the market share argument The Childrens Research Unit in 1988 produced a study which looked at the role of advertising and other contibutory factors in encouraging juveniles to start smoking in New Zealand and ten other countries. On the basis of a 11-country comparison, strong evidence was found to support the view that advertising plays only a miniscule role in the initiation of smoking by the young, and that instead it is the parents, siblings, and friends who appear to be the determining factors. It is argued that all eleven countries reported the similar overwhelming impact of social and cultural influences on juvenile smoking initiation. The Childrens Research Unit therefore suggested that their findings raise questions about the effectiveness of tobacco advertising bans and that advertising may be being made a scapegoat for juvenile smoking.

A 16 country study of the percieved role of advertising and other factors on juvenile smoking initiation was again conducted by The Childrens Research Unit (1989). This report claims once again that advertising plays a negligible role in the initiation of smoking by the young. Instead, personal curiosity, as well as parents, siblings and friends, appear to be the determining factors when children start to smoke, irrespective of the extent of advertising controls and of the presence or absence of such advertising. Again in 1991, The Cbildrens Research Unit prepared a document for the Tobacco Institute of New Zealand which looked at the relationship between tobacco sponsorship and smoking initiation in New Zealand children aged 10 to 16 years. It was found that sponsorship did not have a significant influence on juvenile smoking initiation. 81% of the subjects claimed to have personal experience of sponsorship and their level of knowlege about what sort of companies sponsored what sort of activities was high and correctly ascribed. 50% of them were able to

77 differentiate between different types of sponsorship and this ability improved with increasing age. Subjects understood the relationship between the sponsor and the recipient, for example, 96% did not believe that if a racing car was sponsored by a tobacco company that the driver would have to smoke the sponsors brand. When asked why they had tried smoking, sponsorship was nominated from a prompt list by only one subject out of 297 who had tried a cigarette. Subjects were more likely to have tried smoking if their parents or guardians were smokers or if their siblings smoked. But the strongest correlation occurred between cigarette trial and smoking behaviour of their friends. All three of these studies were initiated and funded by the tobacco industry and conducted by the Childrens Research Unit. It can be argued therefore that until independent research is done, the current evidence overwhelmingly supports the view that there is a causal link between tobacco advertising and the uptake of smoking by adolescents.

2.13.2 Adolescents - the market target?

"cigarette advertising associates smoking with enjoyment of life. Specifically, the advertising connects smoking with popular music, enhanced sexuality, popularity, and general happiness - overa14 a very appealing message to adolescents " (Edmundson et al., 1991) The tobacco industry spends huge sums of money to create an atmosphere in which smoking is an attractive and desirable behaviour (Syme and Alcalay, 1982; Burns, 1991) and influence people to smoke cigarettes (Breslow, 1982).

"This expenditure seeks to portray cigarette smoking as a pleasurable, relaxing activity associated with social success, virility and femininity. Hence, it tends to appeal to young people who are searching for these aspects of adult life" (Breslow, 1982).

Ritchie (1988) questioned New Zealand adolescents (10 to 16 years of age) on their awareness of, and attitudes towards cigarette advertising, and on their image of the young smoker. The majority felt that tobacco companies advertise to encourage people to buy their brands. Smokers were less likely than non smokers to feel that cigarette companies advertise to encourage adolescents to take up smoking. They were also more likely to agree that cigarette companies are generous, public spirited people. Non smokers were more likely to feel that cigarette advertising is effective in encouraging adolescents to smoke. Winfield, the most popular brand among smokers, was also the most well known. Smokers had a more positive image then non smokers of the young person whosmokes. Woodward et al. (1989) report that children in South Australia have been found to smoke the brands promoted through sport. Woodward et al. argued that the view that advertising encourages only brand switching stretches credulity since each tobacco company needs to attract its new share of new smokers annually, simply to make up for those Who give up or die of smoking related diseases.These smokers are in most cases children or adolescents. They also argued that the tobacco industry know this, for example, a Philip Morris executive was quoted as saying in response to the South Australian and Victorian legislation: "We anticipate that there will be a gradual decline of the market because of our inability to effectively advertise the product".

78 In another Australian study, Armstrong et al. (1990) found that childrens perceived responses to cigarette advertising showed the strongest and most consistent evidence of an effect on the uptake of smoking by children who were initially non smokers. This association became stronger over time. Klitzner et al. (1991) examined the relationship between cigarette advertising and smoking experimentation by adolescents. Using environmental and psychological measures of advertising, it was demonstrated that adolescents who experimented with cigarettes were better able to recognise advertised products than those who had not, a selective exposure effect. Conversely, subjects who were better at recognising advertised brands were more likely to have experimented with cigarettes. Klitzner et al. claim that this effect was due to these subjects exposure to cigarette advertising.

Vickers (1992) argued that children are influenced by cigarette advertising as studies show that those who pay attention to cigarette advertisements are likely to change their views in favour of smoking; with those who approve of the advertisements being twice as likely to become smokers. She also stated that children who smoke more readily recall, recognise, and identify cigarette advertisements, thus it seems likely that cigarette advertising encourages them to continue the habit. ASH (1992 B) cites a British survey which found that children who start smoking at the age of 11-14 choose the most heavily advertised brands. They also found that many adults chose cheaper less advertised brands. They concluded therefore that childrens choice is more influenced by advertising than adult smokers. Laugesen and Meads (1988) found in their New Zealand study that the main new downmarket heavily advertised brand (Peter Jackson) not only tended to raise cigarette sales when it is advertised, but it attracted the custom of 4% of New Zealand teenage (10-19 years) smokers withing 2 years of its launching. Laugesen and Meads state that firms advertise regular and upmarket brands to increase, maintain, or protect their market share of these brands, but the advertising of new downmarket brands has an additional effect, to recruit the young, and increase market size. Youthful smokers, smoking a brand with an image that appeals to youth, thus replace the middle aged old brand or upmarket brand smokers who quit.

Other indications that the tobacco industry may be actively marketing cigarettes to the young are such sales campaigns as the recent one based on a cartoon character called "Joe Camel" (Patterson, 1992). ASH (1992 C) reported that studies have found that 6 year old children know Joe better than Mickey Mouse and that Joe is selling Camel cigarettes so successfully that illegal sales of Camels to minors is believed to have rocketed from $6 million to $476 million a year. Another indictaion is imbedded advertising in films such as "Who Framed Roger Rabbit" (Patterson, 1992).

Another possible case of covert cigarette advertising for children may the sale of candy and bubble gum cigarettes which are packaged to resemble cigarette brands. Klein et al. (1992) examined the question of whether such candy cigarettes encourage children to smoke. They found that young children in the focus groups played with the candy cigarettes more than with other candy or snack items and made general references to smoking behaviours. Older children made favourable references to smoking behaviour; most knew which stores sold candy cigarettes, and many had chosen to buy and use these items, desite parental disapproval.

79 Candy cigarettes were viewed favourably and as illicit or mature pleasures by children. When students were surveyed, it was found that one in four children reported having repeatedly purchased candy cigarette products and a history of repeated candy cigarette purchase was correlated with experimental tobacco use. This effect remained significant even after the sample was stratified by parents smoking status. In conclusion, Klein et al. felt that while candy cigarettes could not be said to cause experimental tobacco smoking behaviour, they did provide opportunities for children to engage in smoking-related play and might play a role in the development of childrens attitudes toward smoking as an acceptable, favourable or normative behaviour. Even more sinister is the fact that despite the brand" names on candy cigarettes being similar enough to real cigarette brand names to warrant trademark infringement lawsuits, little meaningful legal action indicating that the tobacco industry does not mind children learning about, playing with, or recognizing their products. Lastly, ASH (1992 D) reported on another devious tactic being used by U.S. cigarette companies. For example, it has been reported that U.S. magazines are displaying full page advertisments with the following headline: "Philip Morris doesnt want kids to smoke". It also stated that:

To continue its long standing commitment that smoking is not for young people, the tobacco industry also has strengthened its marketing code and is supporting state legislation to make it tougher for young people to buy cigarettes". The tobacco institute in the U.S. has also made a series of ads for tv and radio which claim to encourage children not to smoke. These moves have been condemned as a calculated campaign to get tobacco advertising back on tv. The American Lung Association also says that such advertising promotes Smoking as an adult habit to

"kids who want to look cool and act like theyre older".

2.13.3 Females and Maori - market targets? In a report on the targeting of women, minorities, the poor, and the young by tobacco companies, Cotton (1990) cites a number of American instances, for example, cigarette brands such as Uptown and Salem Box which have been marketed in inner city Black communities and the campaign for Dakota cigarettes which have been marketed to "virile females". A discussion document commissioned by Reid and Pouwhare (1991) looked at the way in which the Tobacco Industry targets ethnic groups through the use of name and price, For example, the Tom Tom brand in Malawi or the Pacific brand in New Zealand are obviously aimed at individuals who identify with the pacific region. Ethnic targeting is done in much the same way as brand names such as Vogue Super Slims which reinforce the belief that women use smoking as a slimming aid. Also it has been found in New Zealand that amongst Maori, Winfield is the most commonly used brand. Winfield has sponsored many sports that are popular with Maori, such as softball and rugby league. This isnt a coincidence but careful marketing strategy. It was estimated that in 1988, the Maori segment of the tobacco market was worth $27 million per annum to tobacco manufacturers in ex factory sales.

2.13.4 Conclusion - to ban or not to ban? On the basis of the evidence presented here, it can be argued that legislative measures to reduce the effects of cigarette advertising should be an essential part of any multiple intervention strategy which aims to prevent the uptake of smoking by adolescents, especially for high risk groups such as female adolescents and adolescent Maori. As Tye et al. (1987) point out:

The consequences of tobacco induced diseases are enormous human suffering and social cost. The evidence linking advertising and promotion with increased smoking, and the resulting disease and death, is sufficiently compelling to warrant that it not be permitted by our society". On the basis of such views it was decided that from 1962 in New Zealand cigarette advertising would not be scheduled in the early evening programme segment of televisions stations and advertising would not be accepted on tv or radio if it encouraged young people to smoke. Since then restrictions have gradually become stricter (1986 - smokeless tobacco was banned; 1988 - the sale of tobacco to persons under 16 was banned under an offence under a regulation of the toxic substances act), (Delany, 1988) The Toxic Substances Board in 1989 argued that a comprehensive policy (raising tobacco prices, public education regarding the health hazards, and a total ban on tobacco promotion) was essential to minimising per capita tobacco consumption and the uptake of smoking by young people. Therefore the Toxic Substances Board recommended that:

(i) Tobacco advertising and sponsorship in all their forms be totally eliminated throughout New Zealand from 1990.

(ii) Specific factual tobacco product information including price be displayed only in specified format at points of sale.

(iii) The Hillary Commission be associated with any efforts to ameliorate the effects of a sponsorship ban on bodies at present recieving tobacco sponsorship monies. In response to such recommendations, the Smokefree Environments Act was enacted by the New Zealand Parliament in 1990. One of the aims of this Act was to reduce regulate the marketing, advertising, and promotion of tobacco products, whether directly or through the sponsoring of other products, services, or events. The major thrust of the legislation was to ban all direct advertising of tobacco products including point of sale advertising; and to phase out tobacco company sponsorship of sporting and cultural events (by June 1993) and establish an alternative sponsorship mechanism.

81 II In March 1993 MPs in New Zealand voted for a compromise to retain the ban, but extended the phase-out period for two years to June 1995 (ASH, 1993 A). II Similar legislation has also been passed in Canada (Kyle, 1990) and other countries in recent years. A It should be noted that whilst this act has been described as "one of the strongest pieces of anti-tobacco legislation ever passed" (Beaglehole, 1991), it leaves loopholes which the tobacco industry can use for their own devices. For example, II an article in the New Zealand Doctor (Alexander, 1993) claimed that "teenagers are continuing to take up smoking in large numbers despite extended national limits on tobacco advertising since December 1990". However Weir (1993) in reply argued that this statement is misleading as although the Snokefree Environments II Act did impose limits on tobacco advertising, it has not removed two powerful forms of tobacco advertising to teenagers. That is, tobacco sponsorship contracts already in existence at the time of the act are allowed to continue to June 1993 and II advertising of tobacco products in retail outlets is also allowed until January 1995. The Toxic Substances board (1989) reported that experience in many countries has proved that partial bans are not enough as the advertising budget is just chanelled II into those avenues which remain legal. For example:

(i) band stretching - using other goods and services, for example, sports clothes II and shoes to promote cigarette brands (WI-b, 1990); (ii) product placement - paying to show cigarette brand names prominently in Ii films or in advertisements for other products (WHO, 1990); (iii) sponsorship of sporting or cultural events (WHO, 1990). II WHO (1990) pointed out that the question of restricting tobacco advertising is an international one since even in countries where restrictions exist there are problems with: 11

(i) the sale of magazines which are printed abroad in countries which do not have advertising restrictions; II

(ii) new mass communications media such as cable and satellite television which beam in cigarette advertsing from other abroad; a (iii) Tobacco industry sponsorship of international events, for example, the football World cup or the Olympic games. N WHO (1990) suggested that all countries should ban the promotion of tobacco by both direct and indirect means. This would entail not only prohibiting the [II advertising of tobacco products, but band stretching to other products, product placement, sponsorship of sporting and cultural events or other institutions by cigarette companies. IN Accomplishment of a total prohibition on advertising can be divided into five main areas of focus: II

[II 82 11 2.13.4.1 Television/radio advertising As early as 1982, Syme and Alcalay argued for the prohibition of smoking advertisements on both television and radio. And indeed in New Zealand, television and radio advertising has been banned since 1963 under a series of "voluntary agreements" between governments and the tobacco companies (McLoughlin, 1990). This ban has been strengthened by the Smokefree Environments Act (1990) but certain loopholes still exist which need to be closed.

For example, WHO (1990) suggested that international agreements should guarantee that satellite television and other international communications media are not used to violate national restrictions on tobacco promotion.

2.13.4.2 Written advertising Amos et al. (1991) competed a survey in 1989 of cigarette advertising and coverage of health aspects of smoking in 86 British magazines with a large female readership. Findings were compared with the results of a 1985 survey which had led to the introduction of new voluntary restrictions in 1986. This agreement stated that magazines with a readership of at least 200,000 women, of whom at least a third are aged between 15 and 24, have not been allowed to accept cigarette advertising. Although there was a decrease in the proportion of magazines accepting cigarette advertising (64% to 42%), the new restrictions failed to cover the most popular magazines. Revenue from cigarette advertising by Womens magazines increased by 10% in real terms between 1985 and 1988. There was a small decrease in the coverage given to health aspects of smoking; a third of magazines were willing to use pictures of people smoking in their editorial pages. Amos et al. argued that these findings show that voluntary restrictions introduced in the U.K have only had a small effect on cigarette advertising and have failed to achieve their aim of protecting young women. It was suggested that the agreement failed due to a number of reasons:

(i) it failed to deal with large circulation magazines, the readerships of which span all ages and which do not fall within the terms of the agreement;

(ii) the agreement was not responsive to fluctuations in magazines readership because its terms were based on an annual rather than a quaterly review of readership figures (new magazines were also not reviewed until the first years readership figures were published); and

(iii) the terms of the agreement did not cover style magazines which are also very popular and iuluential with young people. Amos et al. also point to other problems such as increasing numbers of new magazines on the market offering new opportunities for cigarette advertising; and contradictory positions on the part of editors, for example, some magazines claimed to reject advertising for products "known to be dangerous" and yet accept cigarette advertising. Amos et al. argued that what is needed is a total ban.

83 Laugesen and Meads (1988) found that "newsitems about smoking issues can decrease cigarette sales and therefore newspapers can have powerful effects on tobacco consumption and public health". Laugesen and Meads argued that newspapers, either by doubling the coverage of smoking issues in their news columns, or by totally banning cigarette advertising, particularly the advertising of new brands with youth appeal, can achieve the same decrease in cigarette sales as a 10% increase in the price of a packet of cigarettes.

2.13.4.3 Tobacco product packaging WHO (1990) suggested that placing numerous rotating and frequently renewed health warnings on tobacco packages is an important part of a comprehensive tobacco policy. Rotating warnings and adding pictorial representations have been found to be useful in creating a greater impact. Can-Gregg and Gray (1990) argued that brand image makes subtle promotion of a product possible in spite of national and state barriers (such as advertising bans) through print advertising and televised coverage of international sponsored sporting events. Therefore Can-Gregg and Gray suggested that "generic" packaging may be a possible solution to the marketing of tobacco to young people. They suggested that the packaging of cigarettes is very important to the buyer who may use it like a part of their wardrobe so as to express how they want to be seen by others in much the same way as costume jewellery or a watch is used. Image might therefore be eliminated by packaging cigarettes in a simple (black and white) package with a description of the product, details of content, a health warning, along with tar and nicotine content, and the name of the manufacturer. Carr-Gregg and Gray argued that such "generic" packaging would help to reduce the impact of devious marketing ploys such as "piggyback" advertising (for example, a Marlboro logo painted on the side of a formula 1 racing car) or parallel marketing (for example, Dunhill watches/briefcases) or the strategic placement of tobacco advertisements in motion pictures (for example, the appearance of Marlboro cigarettes in Superman II). If all tobacco products looked alike there would be less incentive to pay for prominent retail displays or to pay to have a brand featured in a movie. Since the advertising image would be very different to the one appearing in the market place, advertising would lose much of its impact. Government health warnings would also be more visible without the clever clutter of packaging. Beede and Lawson (1992) investigated the possible effects upon perceptions of health warnings by adolescents (aged 13) when cigarettes are presented in plain packaging. The presentation ofhealth warnings in the context of plain packs achieved a significantly greater recall rate as opposed to brand packs. When lessbrand image cues were presented, respondents were able to perceive and recall with more accuracy a greater proportion of non-imageinformation. Besides using plain packs, a number of other suggestions were made to increase the impact of the warning, for example, increasing the size of the warning, displaying the warning in a boxed area to separate it from other information, printing the warning on the cigarette itself. Beede and Lawson argued that selling all cigarettes in plain packs would heighten the awareness of health warnings and inhibit the promotional impact of the package itself. In the context of promotion, it would also render other forms of advertising and sponsorship less efficient and over time the learned associations

84 between the physical product and the brand symbols (names, colour, logos) used in advertising would be extinguished. Carr-Gregg and Gray argued that the rationale for the move to generic packaging is that "tobacco should be treated as the toxic, addictive, and ultimately lethal substance that it is, and responsible governments should not allow cleverly designed and enticing packaging to promote a product if they have decided to end promotion of that product".

2.13.4.4 Tobacco company sponsorship Tobacco companies often sponsor organizations and events which otherwise would find it hard to obtain money, for example, the National Association of Black Journalists and the Virginia Slims Womens tennis. (Cotton, 1990) In New Zealand in 1975, there were 19 hours of tobacco sponsored events on television; by 1981, there were 54 hours; and by 1986, there were 182 hours. These numbers only include direct telecasts, not replays or exerpts. It also appears that tobacco money goes largely into the "glamour" events, for example, the international cricket, tennis and motorsports, which get the most hours of television coverage. (McLoughlin, 1990) WHO (1990) argued that every sporting event should be smokefree and free from all tobacco advertising and promotion. The Olympic ganes is particularly important in this respect; and it is suggested that all future Games should follow the smokefree practice established by the 1988 Calgary Winter Olympics. One way in which New Zealand has tried to soften the ban on tobacco advertising through sponsorship has been to provide a fund to replace tobacco sponsorship of sports and the arts. (McLoughlin, 1990)

2.13.4.5 Other

WHO (1990) suggested that the promotion of new methods of nicotine delivery, for example, oral smokeless tobacco should be banned in countries where it is not already in use. Elimination of candy cigarettes should be part of efforts to prevent initiation of smoking by children (Klein et al., 1992).

85 2.14 Limitations on where smoking is allowed This refers to restriction of where people can or cannot smoke, that is, on schools, aeroplanes, worksites, restaurants, and hospitals. Cummings et al. (1991) stated that: "restrictions on smoking in the worksite and other locations change the social acceptability of smoking and may increase the number of individuals who try to quit and who have long term success after cessation " In preventing the uptake of smoking by adolescents, restrictions on smoking at school and in the wider community may be very important in establishing social norms that state very clearly that smoking is NOT okay (Reid, 1985; Brink et al., 1988; Hynes, 1989; Glynn, 1989). For example, Brink et al. (1988) suggested that messages in smoking education programmes must be reinforced by a social environment within the school that supports no smoking and communicates non smoking as the norm. Features of school smoking policies might include: smoking restrictions for school teachers and visitors; smoking bans inside the school or on school transport; strict penalties for violators; prevention and cessation programmes provided; smokers and their parents required to attend a smokers clinic; and policy clearly communicated to both staff and pupils.

Restrictions on smoking in the wider community is also important in communicating anti-tobacco norms. The Smokefree Environments Act (1990) which aimed to reduce the exposure of people who do not themselves smoke to any detrimental effect on their health caused by smoking by others has been very important in the creation of such norms. One of the major thrusts of this Act was to require employers to draw up in consultation with employees a policy (with certain minimum requirements) to protect the rights of workers to a smokefree environment. One of the anomolies of the Act however is that it made no special provisions for schools to be smokefree (ASH, 1993 B).

2.14.1 Conclusions Therefore it must be argued that for any anti-smoking education in schools to be successful, there must be a corresponding sense of disapproval of smoking out in the wider community as evidenced by restrictions on where smoking is or is not allowed.

0 2.15 Multiple level interventions Reductions in cigarette smoking initiation among adolescents may be accelerated if school based prevention programmes are complemented by health promotion activites in the surrounding community (Resnicow et al., 1991; Perry et al., 1992). A number of overseas studies have found very positive results for multiple level interventions. Pentz et al (1989) evaluated the longitudinal effects of the Midwestern prevention project on regular and experimental smoking in adolescents. Schools were either assigned to a school and community based programme for prevention of cigarette, alcohol, and marijuana use or a health education as usual group. In Kansas City, the local name was Project STAR (Student Taught Awareness and Resistance). This programme consisted of: Fall 1984 to Fall 1985: - 10 session school programme for resisting and counteracting drug use influences, and prevention practice homework activities with parents; - 31 news clips, commercials, talk shows, press conferences and articles covering baseline drug use and STAR goals in Kansas City, introduction of each programme component, skills demonstration, and public recognition of participating students and implementors.

Fall 1985 to Fall 1986:

- 5 session booster school programme for maintaining resistance skills practice, counteracting influences anticipated in the transition to high school, and homework activities with parents; - a minimum of three planned meetings and one educational seminar per year, a parent organization programme for training parents in parent-child communication and prevention practice support skills, and organizing to change school policies about institutionalizing drug prevention curricula and restricting drug use in and around schools; - 39 mass media events and programmes. The school and booster programmes were delivered in regular health, science, or social studies classes by teachers, using modeling, role-playing, group discussion, and peer facilitation methods of instruction. Using school of origin as the unit of analysis, programme effects showed 1 year net reductions of -8%, -6%, and in prevalence of smoking in the last month, last week, and last 24 hours. Two year programme effects showed similar net reductions of -6%, -5%, and -3%. Therefore it was found that from baseline through the first two years, the programme appeared to be significant in reducing experimental and regular smoking in adolescents. The findings did suggested however that the programmes effects were somewhat diluted by two year follow up. The results of the project at two year follow-up represent the cumulative effects of the school programme, the school booster programme, the parent organization programme, and mass media programming.

87 Griffin (1990) evaluated the efficacy of a state wide tobacco use prevention programme participated in by Minnesota schools since 1985. In 1984, an advisory committee on non smoking and health made recommendations in each of five areas: school and youth education, public information and education, public and private regulatory measures, economic measures, and informational needs. Based on these recommendations, the state legislature increased the state excise tax by five cents in 1985. One cent of the tax increase was put into a public health fund, one quarter of which was set aside for tobacco use prevention and a major statewide initiative was launched to promote non smoking (for example, media campaigns) with state aid being established for comprehensive tobacco use prevention in schools. School districts were eligible for funds if they indicated that they were willing to meet five eligibility requirements: provide in-service training on smoking prevention to teachers and staff; provide a kindergarten through grade 12 continuum of education interventions related to tobacco use prevention; provide a targeted tobacco use prevention programme for 12 to 14 year olds based on evaluated curricula shown to reduce the onset of tobacco use; prohibit the use of tobacco products on school premises by minors; evaluate programme results. At the end of each year, school were required to submit a report describing how they complied with these criteria. A model was developed for a comprehensive school based approach based on social learning theory and problem behaviour theory. The model encouraged environmental support for non smoking at the school, family, and community level; addressed personality factors including knowledge, values, and attitudes about tobacco use; and seeked to increase students behavioural skills including increasing intentions to remain tobacco free, resisting peer influences, and tobacco cessation strategies for those who use tobacco. There were five main component areas:

(i) education programmes to continue from kindergarten throughout the school years.

(ii) Intensive prevention programmes for students between the ages of 12 and 14. (iii) Tobacco free school policies. (iv) Quit programs for tobacco users.

(v) Family and community support for tobacco use prevention (for example, an increase in penalties for the sale of tobacco products to minors). Results from an evaluation (Griffin, 1990) indicated that as many as 97% of Minnesota schools voluntarily participated in the programme in 1989-1990 and that 82% of schools had voluntarily adopted a policy that prohibited tobacco use for students, staff, and visitors. Initial data on changes in tobacco use rates were also encouraging, for example, among ninth graders (15 years of age), experimentation with tobacco products declined from 1986. In 1986, 59% reported smoking cigarettes at least once, compared with 55% in 1988. 62% had tried smokeless tobacco in 1986 while only 49% had in 1988. Weekly smoking rates did not change, but weekly use of smokeless tobacco by ninth grade males declined

[Ill [Sr.]

from 13% in 1986 to 10% in 1988. It was felt however that it was too early to assess the overall effectiveness of the programme despite encouraging results.

Murray et al. (1992) also evaluated the efficacy of the 1985 Minnesota intervention through the use of two studies. Firstly, a four group comparison study which randomly assigned schools to one of four conditions (including a control group) was conducted so as to evaluate the three middle school interventions that were most widely adopted by Minnesota school districts. The three interventions selected for evaluation were:

(1) the Minnesota prevention programme - a six lesson curriculum based on the social influences model;

(ii) the Smoke free generation programme - a three lesson curriculum patterned after the Minnesota prevention programme but in a shorter form; it also used T-shirts, posters and similar promotional items to encourage non smoking;

(iii) the Minnesota Department of Educations Guidelines which were developed by the Department of Education and provide written guidelines and a workshop to help teachers adapt existing programmes to incorporate components of the social influences model. The study indicated that none of the interventions was more effective in reducing adolescent tobacco use compared with a randomized control group, that is, there were no differences in tobacco use prevalence at the end of the study either among the four conditions or between them and the State of Minnesota as a whole, nor were there any differences among the four conditions in tobacco use incidence. Therefore there was a lack of evidence that the social influences interventions were any more effective than the existing curriculum control condition. In the second study, a two state comparison study was conducted which determined changes in tobacco use patterns in Minnesota relative to Wisconsin. The two state study revealed a modest net decline (2.4%) in Minnesota relative to Wisconsin from 1986 to 1990, but this decline was within the range of chance variation. Murray et al. concluded that the legislative initiative was insufficient to reduce adolescent tobacco use statewide during the 5 year study period. They argued that together with results from other recent studies, they suggested that even more intensive efforts may be required to effect widespread reductions in adolescent tobacco use.

Fan and Fisher (1991) evaluated the Bring your body back to life campaign which attempted to target blue collar workers in Western Australia. The campaign combined mass media, workplace initiatives, and community based activities to motivate and encourage smokers to quit. The evaluation results and non formal feedback indicate that it did have an impact in terms of: raising awareness about quitting and its benefits, increasing the number of attempts to quit, and the number of successful quitters.

Roberts et al. (1991) also evaluated a multiple level intervention quit campaign in South Australia. The 1989 quit campaign used television., radio, cinema and press advertising, plus outdoor advertising in form of billboards and signage at

89 sporting events. At the community level, quit campaign information packages were sent to community health centres, libraries, hospitals, and local councils, doctors and other health professionals. Displays and activities occurred in many local communities. Teacher information packages were sent to all schools in South Australia. There was a quit information display at the Royal Show supported by media, sport and music celebrities. A range of promotional materials was used throughout the campaign, such as windcheaters, display signage, balloons and posters. The five day quit book was also widely distributed. A telephone information service - the quitline - was established top rovide an ongoing 24 hour service, with a recorded message giving advice as well as a telephone number to call for individual telephone counselling - the quit advisory counselling service. Reported awareness of the campaign was high especially among those aged 15-39 years. More smokers recalled quit smoking advertising than non smokers. Television and radio appeared to be the most appropiate for reaching younger smokers, with higher rates of recall among this group. Over 20,000 five day quit books were distributed; as were 10,000 posters; 12,000 smoke gets in your eyes brochures for women; and 5,000 young people and smoking pamphlets for parents and teachers. There was good community support for the campaign and packages of resources were sent to 150 different health and community centres throughout South Australia. Over 6,000 calls were made to the quitline and over 700 people received individual telephone counselling and were sent quit kits. Worksite based adult intervention programmes also have implications for school based adolescent programmes. Shi (1992) conducted the Healthwise Stepped Intervention Study (1988-1990) at Pacific Gas and Electric to evaluate how a health promotion programme affects behaviour change and whether increasing levels of preventive interventions improve health status. A four level stepped intervention structure was used. The basic intervention components consisted of health risk assessment and health newsletter (levels 1,2,3,4). Additional interventions were health resource center and self-care books (levels 2,3,4); behavioural change workshops/classes and Division Healthwise team (levels 3,4); and case management and environmental policy (level 4). The overall risk status significantly improved at all four intervention levels. The comparison across the four intervention levels found that level 4, combining environmental policy with "high risk" targeting, showed the most impressive performance. Participants in level 4 consistently showed significantly greater improvement in life-style factors, and their overall risk status also showed the greatest improvement. The six risk behaviours used for testing were: cigarette smoking, alcohol abuse, lack of exercise, unsafe driving, poor dietary habits, and uncontrolled hypertension. On the smoking factor, a sharp decline in prevalence ranging from 18% to 44%, was observed across all four intervention conditions. The comparison across levels showed that level 4 had the greatest decline, and both level 3 and level 1 had greater decline rates than level 2. Such environmental influences as persistent publicity through the Healthwise Newsletter and division policies to discourage smoking were believed to account for the sharp decline. The onsite smoking cessation programmes and case management (health education that discouraged smoking at the worksite and made it clear that the social norm of the company is a non smoking environment) made additional contributions to the decline for level 3 and 4. It was found that stopping smoking requires a major effort initially, but the impulse to smoke diminishes in frequency and intensity over time. They conclude that we think a comprehensive health promotion programme that combines environmental policy with high risk targeting is the only approach that will sustain behavioural changes".

- t - 2.15.1 Conclusions If a significant reduction in the uptake of smoking by adolescents is to be achieved, multiple level interventions which focus on both the individual and the environment in which the individual operates, must be employed. Such multiple level interventions should include the six interventions outlined in this review: school based smoking prevention/cessation programmes, media campaigns, access to tobacco restrictions, increased taxation of tobacco, tobacco advertising bans, and limitations on where smoking is allowed.

91 Chapter 3 Smoking survey 0112-17 year old school children

3.1 Introduction

Approximately 50 New Zealand children take up smoking every day (Carr-Gregg and Gray, 1989).

The National Research Bureau surveyed 1600 New Zealand teenagers aged between 10-15 years in 1989 and again in 1991 (N.R.B., 1989; 1991). The key findings of the 1991 survey include:

• The incidence of regular smoking in 10-15 year olds was 4% (5% in 1989) Only 1% of 12-13 year olds were classified as regular smokers while 11% of 14-15 year olds were regarded as regular smokers. Girls (5%) are taking up the smoking habit at nearly twice the rate of males (3%).

• Passive smoking exposure varied across ethnic groups from 54% of Maori respondents compared with 27% of European respondents exposed to passive smoke.

The main cigarette brands recalled and activities associated with brand sponsorship were:

• Winfield (16%) rugby league • Rothmans (13%) cricket • Benson & Hedges (12%) fashion show/awards • Pall Mall (5%) no particular activity stood out • Peter Jackson (3%) motor racing/car racing • Marlboro (2%) motor racing/car racing • 14-15 year olds would seem to have no trouble purchasing cigarettes, with 69% saying they get cigarettes in this way. • About half the sample (57%) said they smoked a particular brand, down from 69% in 1989.

• Those who are smoking regularly, smoke on average 10.9 cigarettes per week, slightly down on the 12.7 cigarettes reported in 1989. Source: National Research Bureau, 1991.

93 II 3.2 Aims 11 The overall aim of this survey was to provide updated information on the nature and extent of smoking behaviour and beliefs in a sample of 12-17 year old New Zealand school children. The specific aims were: II • To determine the incidence of past and present smoking behaviour examined by age, gender, ethnicity and place of domicile. U • To examine the awareness of advertising and brand promotion of tobacco products and their association through sponsorship with sporting and non- sporting events in a random sample of 12-17 year old school children. Amongst current smokers, to describe the number smoked per week, sources of cigarettes, and brand(s) smoked and why.

3.3 Methods The student smoking survey was conducted with a randomly selected sample of secondary school pupils from 14 high schools in five areas. Seven of the schools were located in main urban centres, four in provincial centres and three in smaller semi rural towns. The pupils selected were also participating in a survey and adolescent sexual behaviours and beliefs being conducted by Health Research and Analytical Services for the New Zealand Planning Association (Lungley, Paulin and Gray., 1993).

3.3.1 Ethnic representation in the sample Sampling procedures were weighted to ensure that a high level of Maori and Pacific Island representation was sampled. The 1991 census indicates there were at the time of the census, 268,790 12-16 year olds living in New Zealand, with 33,135 (12%) identified as Maori. Ten percent of 12 year olds identified as Maori compared with 19 percent of 16 year olds. Following the use of weighted sampling formula, 18 percent of the survey population was Maori. However, only 4 percent of the survey population was Pacific Island.

3.3.2 Data Collection

The survey was a self-administered questionnaire (see Appendix 1) completed at school. Demographic information sought included: age, gender, ethnicity and place of residence. The questionnaire was administered by contractors, which were public health nurses in all schools, except one. A Health Research and Analytical Services researcher introduced the questionnaire to the students and explained the puose of the survey. The students then completed the questionnaire with the researcher present to answer questions.

94 3.3.3 Response Rate

Table 3.1 below shows the responses obtained from each school where the smoking survey was distributed.

Table 3.1. Smoking survey and response distribution across high schools.

Area School Respondents

Auckland Rangitoto College 68 Takapuna Grammar 74 James Cook High School 44 Mangere College 35

Hawkes Bay Colenso College 63 Taradale High School 74 Wairoa College 58 Central Hawkes Bay 79

Wellington 1 Wellington East Girls 64

Nelson Waimea College 66 Nayland College 35 Canterbury Aranui High School 76 Rangiora High School 33 Cashmere High School 81 tSlflur.xwii 36

Total sample size 890

1 Two schools in the Wellington region declined to participate in the student smoking survey and as a consequence the numbers from this region are lower than expected. Also; the resulting Wellington sample comprises female students only. The final ample size was 890 students ranging in age from 12 to 17 years. One hundred and five questionnaires were returned uncompleted giving a high and acceptable response rate of 89 percent (890/995).

95 U 3.4 Results

3.4.1 Description of the sample 11 The total number of respondents was 890 students. The following tables provide a sample description by gender, age, and ethnicity.

Table 3.2 Gender description of the sample.

Gender N %

Female 510 57.3 Male 369 41.5 Not known 11 1.2 CI For the purposes of comparison with the National Research Bureau surveys (1989,1991) a second composite age grouping was made, as illustrated below. fl Table 3.3 Age description of the sample.

Age N

12 2 0.2 13 178 20.0 14 211 23.7 15 188 21.1 16 229 25.7 17 69 7.8 Not known 13 1.5

Age N

12-13 180 20.2 14-15 399 44.8 16-17 298 33.5 , Not known 13 1.5 U El 96 CI

NOTE

All age related data are compromised by the nature of the sample i.e. all school children. It is likely that the 16-17 year olds in the sample on average have higher intelligence, higher socio-economic status etc. than both the lower age groups in the sample and the total population of their own age.

Table 3.4 Ethnicity of the student sample

WV %

European/Pakeha 611 68.7 Part European, part Maori 71 8.0 Maori 67 7.5 47Other 5.3 22Samoan 2.5 19Chinese 2.1 Kiwi/New Zealander 16 1.8 Cook Islander 9 1.0 Nuiean 4 0.4 Cambodian 3 0.3 Tokelauan 2 0.2 Vietnamese 2 0.2 Not known 17 1.9

In the text the sample is divided into two ethnic groups - Maori (both Maori and Part-Maori combined) and Non-Maori (all other ethnic categories combined). Data relating to two additional ethnic groupings are contained in the appendix 2.

Ethnic Group N %

Non-Maori 719 80.8 Maori 138 15.5 33Not known 3.7

Whereas 12 percent of the New Zealand 12-16 year olds identified themselves as Maori at the 1991 census, 15.5 percent of our sample of 12-17 year olds identified themselves as Maori.

97 Table 3.5 Place of residence of the student sample

Area N

Auckland 225 25.3 Hawkes Bay 274 30.8 Wellington 64 7.2 Nelson 101 11.3 Canterbury 190 21.3 Not known 36 4.0

The low percent return for Wellington is attributed to two schools in the Wellington region declining to participate in the student smoking survey. Additional demographic data about the sample are contained in the appendix 2.

3.4.2 Smoking history of the student survey sample.

Table 3.6 Question I : "Have you ever smoked a cigarette?" [smoking history].

I have never smoked 256 29.3 I have only tried smoking once 160 18.3 I have smoked more than once 202 23.1 I have smoked lots of times 255 29.2

[No. of respondents = 873] Half the sample reported smoking once or never at all, while the other half of the students reported smoking more than once or lots of times.

ci 98 Table 3.7 Smoking history by Gender

Females Male

Never smoked 29 30 Tried smoking once 14 24 Smoked more than once 23 23 Smoked lots of times 35 22

[Chi-Square p = 0.000 Sample Size = 835 ]

Seventy percent of both males and females in the sample had smoked at least one cigarette.

Table 3.8 Smoking history by Gender - [for those who have tried smoking].

Females Male

Tried smoking once 20 36 Smoked more than once 32 33 Smoked lots of times 48 31

[Chi-Square p = 0.000 ] Of those who tried smoking, more females(80%) than males (64%) went on to smoke again. More females (48%) than males (3 1%) had smoked "lots of times".

Table 3.9 Smoking history by Age (years)

• 13 14 15 16 17

Never smoked 44 36 21 22 21 Tried-smoking once 17 17 17 23 19 Smoked more than once 19 18 27 25 32 Smoked lots of times 20 29 36 31 28

[Chi-Square p = 0.000 Sample Size = 858]

11 Taken at face value, these figures suggest that children first try smoking at some time before the age of 15 years. By age 15 time 80% have tried. After that few try smoking for the first time. 11 There are two problems with these age related data. The first is the non-random nature of the older sample (mentioned above), the second the lack of information II relating to date of birth - i.e. whether the same results would be obtained from a series of cohort samples one year apart. It might be useful in the future to ask the question "At what age did you try your first cigarette?" II Table 3.10 Smoking history by Age: [for those that have tried smoking] II 13 14 15 16 17 II

Tried smoking once 30 26 21 29 24 Smoked more than once 34 28 34 32 41 Smoked lots of times 36 46 45 40 35 II [Chi-Square p =0.548 Sample Size = 858] II For those who have tried smoking, there is no statistically significant difference between the age groups. Twenty-thirty percent did not smoke again after their first cigarette, 30-40% have smoked occasionally, and 30-40% have A smoked "Lots of times". II Table 3.11 Smoking history by Age: Females II 13 14 15 16 17 II Never smoked 49 35 19 20 22 Tried smoking once 13 13 15 16 9 Smoked more than once 19 17 25 26 31 U Smoked lots of times 19 36 41 37 37 11

[Chi-Square p =0.000 Sample Size = 499] II II ii 11 100 U Table 3.12 Smoking history by Age [for those who have tried smoking once]: Females

13 14 15 16 17

Tried smoking once 25 20 19 21 11 Smoked more than once 38 25 30 33 41 Smoked lots of times 38 55 51 47 48

[Chi-Square p = 0.649 Sample Size = 355]

Again, the difference between the age groups relates to the percentage who have tried smoking. Fifty percent of females have tried smoking by age 13, 65% by age 14, and 80% by age 15. Of those who have tried smoking, more females in the 14- 15 age group admit to smoking "lots of times" than 13 year olds, but the overall difference between the age groups is not statistically significant.

Table 3.13 Smoking history by Age: Males

13 14 15 16 17

Never smoked 38 38 25 24 18 Tried smoking once 22 21 21 32 30 Smoked more than once 19 20 30 23 33 Smoked lots of times 22 22 25 22 18

[Chi-Square p = 0.271 Sample Size = 358] In the 13-14 age group 40% of males have tried smoking more than once. This increases to 80% by age 17. Conversely, there is a group of individuals, around 20 percent of our sample, who have not smoked by the age of 17 years and quite possibly will not take up the smoking habit. It may be important in the future to focus some research effort into determining what factors contribute to these individuals remaining non-smokers.

101 U

Table 3.14 Smoking history by Age [for those who have tried smoking] : Males [I

13 14 15 16 17

Tried smoking once 35 33 28 41 37 Smoked more than once 31 32 40 30 41 Smoked lots of times 35 35 33 29 22

[Chi-Square p = 0.841 Sample Size = 249 1 U For those males who have tried smoking, there is no statistically significant difference in further smoking behaviour between the age groups. These figures suggest that the act of trying that first cigarette is the important one in determining smoking behaviour thereafter. U Table 3.15 Smoking history by Ethnic group U Maori Non-Maori U Never smoked 16 32 Tried smoking once 17 18 Smoked more than once 28 22 Smoked lots of times 39 28 U

[Chi-Square p = 0.001 Sample size = 835 1 Twice as many Maori in our sample have tried smoking than non-Maori. More U Maori have smoked "lots of times" than non-Maori. These differences between Maori and Non-Maori students in our sample were statistically significant suggesting these differences are real. U U ci ci U 102 - U Table 3.16 Smoking history by Area

Auckland Hawkes Bay Wgtn Nelson Canty

Never smoked 33 23 33 33 26 Tried smoking once 19 14 19 19 23 Smoked more than once 23 26 16 16 27 Smoked lots of times 24 38 33 31 25

[Chi-Square p = 0.000 Sample size = 835 ] Smoking behaviour is noticeably higher in the Hawkes Bay sample, which contributed to a statistically significant pattern in reported smoking behaviours in students between the sampled regions.

Table 3.17 Smoking history by Gender: Age 12-13

Females Male

Never smoked 46 38 Tried smoking once 13 22 Smoked more than once 22 18 Smoked lots of times 19 21

[Chi-Square p = 0.379 Sample Size = 169] In the 12-13 age group there is no significant difference in smoking behaviour between the sexes. While 46 percent of females and 38 percent of males have never smoked, one in five male and female students stated they had smoked lots of times. So at this age, both males and fernales.are experimenting with smoking with equal frequency.

103 Table 3.18 Smoking history by Gender: Age 14-15

Females Male

Never smoked 28 33 Tried smoking once 12 19 Smoked more than once 22 24 Smoked lots of times 39 24

[Chi-Square p = 0.015 Sample Size = 369] In the 14-15 age group approximately 70% of both males and females have tried smoking once, but significantly more females have gone on to smoke "lots of times". While two in ten 12-13 year old female students reported smoking lots of times, this has doubled to four in ten for the 14-15 year olds. So by the age of 15 years, and still under the legal age for purchase of cigarettes, nearly half the female students reported either previously or currently smoking lots of times. By comparison, one in five male 12-13 year old students reported smoking lots of times which rose slightly to one in four for the 14-15 year old age group.

Table 3.19 Smoking history by Gender: Age 16-17

Females Male

Never smoked 21 23 Tried smoking once 14 31 Smoked more than once 26 25 Smoked lots of times 38 22

[Chi-Square p = 0.002 Sample Size = 278] In the 16-17 age group 80% of both males and females have tried smoking, but nearly twice as many females (64%) than males (47%) continued to smoke after their first cigarette. Also, it is clear from these results that the higher level of reported smoking by females that is noticeable by the ages of 14-15, continues to be present in the 16-17 year age group.

104 Table 320 Smoking history by Gender: Maori

Females Male

Never smoked 16 19 Tried smoking once 8 27 Smoked more than once 25 35 Smoked lots of times 52 19

[Chi-Square p = 0.001 Sample Size = 125]

In our sample, over 80% of both male and female Maori had tried smoking. Three times as many females continued to smoke after that first cigarette with the result that more than twice as many females (52%) as males (1901o) went on to smoke "lots of times".

Table 3.21 Smoking history by Gender: Non-Maori

Females Male

Never smoked 32 33 Tried smoking once 14 23 Smoked more than once 23 21 Smoked lots of times 32 23

[Chi-Square p = 0.004 Sample Size = 691] Of the Non-Maori sample, 70% of both males and females have tried smoking. Thirty-two percent of females and 23% of males reported they had smoked "lots of times". There is a significantly greater amount of smoking behaviour among females but the difference is not as great as for Maori. For example, whereas one in two Maori female students reported smoking lots of times, only one in three Non-Maori female students reported smoking lots of times.

105 Table 3.22 Smoking history by Age: Females

12-13 14-15 16-17

Never smoked 46 28 21 Tried smoking once 13 12 14 Smoked more than once 22 22 26 Smoked lots of times 19 39 38

Chi-Square p = 0.001 Sample Size = 482 J

There was a significant change in reported smoking history of female students across age groups. Twice as many female 12-13 year olds reported never smoking in comparison with 16-17 year olds. Also, twice as many 16-17 female students reported smoking lots of times in comparison with 12-13 year old female students.

Table 3.23 Smoking history by Age: Males

12-13 14-15 16-17

Never smoked 38 33 23 Tried smoking once 22 19 31 Smoked more than once 18 24 25 Smoked lots of times 21 24 22

[Chi-Square p = 0.206 Sample Size = 334]

Both males and females are more likely to have tried smoking as they got older, but the overall percentage smoking "lots of times" increases with age for females but not males. U ci

U 106 ci

Table 3.24 Smoking history by Age: Maori

12-13 14-15 16-17

Never smoked 36 16 14 Tried smoking once 9 5 26 Smoked more than once 18 27 33 Smoked lots of times 36 52 28

[Chi-Square not valid Sample Size = 125 ]

There were only 13 Maori in the 12-13 age group. Maori in the 14-15 age group were five times more likely to continue smoking after the first cigarette with the consequence that nearly twice as many in the 14-15 age group became regular smokers (52%) in comparison with the 16-17 age group (28%).

Table 3.25 Smoking history by Age: Non-Maori

12-13 14-15 16-17

Never smoked 43 32 24 Tried smoking once 18 17 20 Smoked more than once 20 22 24 Smoked lots of times 19 29 33

[Chi-Square p = 0.006 Sample Size = 691 ]

Among Non-Maori, 57% of the 12-13 age group had tried smoking. This figure increased to 76% in the 16-17 age group. The percentage of regular smokers increased from 19% in the 12-13 group to 33% in the 16-17 group. In the 12-13 age group Maori were more likely both to start smoking and to become regular smokers than Non-Maori, but the numbers in these groups were small.

In the 14-15 age group more than twice as many Non-Maori (32%) as Maori (16%) had never smoked. Fifty-two percent of Maori became regular smokers while only 29% of Non-Maori did so.

107 In the 16-17 age group, there was no significant difference in smoking behaviour among Maori and non-Maori subjects.

Table 3.26 Smoking history by Ethnic group : Females

Maori Non-Maori

Never smoked 16 32 Tried smoking once 8 14 Smoked more than once 25 23 Smoked lots of times 52 32

[Chi-Square p = 0.002 Sample Size = 482]

Twice as many Non-Maori females had never smoked (32%) as Maori females (16%). More Maori females (52%) went on to become regular smokers in comparison with Non-Maori females (32%).

Table 3.27 Smoking history by Ethnic group : Males

Maori Non-Maori

Never smoked 19 33 Tried smoking once 27 23 Smoked more than once 35 21 Smoked lots of times 19 23

[Chi-Square p = 0.066 Sample Size = 334]

For males there was no statistically significant difference in smoking behaviour between the two ethnic groups. Therefore any significant Maori versus Non-Maori differences in smoking behaviour are primarily the result of the higher level of smoking reported by Maori female students.

U U 108 U Table 3.28 Smoking history by Area: Female

Ackind Hwks Bay Wgton Nelson Canty

Never smoked 32 23 32 37 22 Tried smoking once 18 8 19 11 14 Smoked more than once 24 23 16 17 31 Smoked lots of times 27 45 33 35 32

[Chi-Square p = 0.038 Sample Size 468]

Table 3.29 Smoking history by Area: Male

Acklnd Hwks Bay Nelson Canty

Never smoked 35 21 30 30 Tried smoking once 21 21 28 33 Smoked more than once 23 29 15 22 Smoked lots of times 21 28 28 16

[Chi-Square p=0.157 Sample Size = 336 ]

There is significant difference between the areas for females but not for males. In particular females in Hawkes Bay smoke noticeably more than in other centres. By comparison, males do not. The higher proportion of Maori females in the Hawkes Bay sample in comparison with the other regions probably contributed to the significant different in smoking behaviours reported by females between the regions.

109

------.- ---- Table 3.30 Smoking history by Area: Maori

Acklnd Hawkes Bay Wgton Nelson Canty

Never smoked 11 15 13 38 17 Tried smoking once 25 14 0 0 33 Smoked more than once 36 25 25 13 33 Smoked lots of times 29 46 63 50 17

[Chi-Square not valid Sample Size = 134]

Table 3.31 Smoking history by Area: Non-Maori

Ackind Hawkes Bay Wgton Nelson Canty

Never smoked 37 25 36 33 27 Tried smoking once 18 14 21 21 21 Smoked more than once 21 26 14 16 26 Smoked lots of times 24 35 29 29 26

[Chi-Square p = 0.086 Sample Size = 670]

The small number of Maori in Wellington, Nelson and to a lesser extent Canterbury make the figures for Maori in these areas unreliable. For non-Maori there is no significant difference between the areas in reported smoking history. U ci H ci ci 110 ci

3.4.3 Current smoking status of the survey sample.

Question II "How many cigarettes do you usually smoke in a week?"[current smoking status].

A. I have never smoked 284 33.2 B. I have tried smoking but I dont smoke now 288 33.6 C. I smoke sometimes but not every week 181 13.8 D. Between 1 and 4 a week 37 4.3 E. Between 5 and 10 a week 38 4.4 F. More than 10 a week 91 10.6

No. of respondents = 856

One third of the sample had never smoked, another third had tried smoking but currently dont smoke and the remaining third were current casual or regular smokers. To permit comparison with the National Research Bureau surveys (1989, 1991) and other New Zealand smoking surveys these categories were combined as follows: A + B => Non-smoker C + D => Casual smoker E + F => Regular smoker

N %

Non-Smoker 572 64.3 Casual 155 17.4 Regular 129 14.5 Not known 34 3.8

111 ci Table 3.32 Current smoking status by Gender [

Female Male

Never smoked 30 37 Tried smoking but dont smoke now 31 37 Smoke sometimes but not every week 15 11 Smoke between 1 and 4 a week 4 4 [] Smoke between 5 and 10 a week 5 4 Smoke more than 10 a week 14 6

[Chi-Square p = 0.000 } U In our sample, slightly more females than males have tried smoking. - U Table 3.33 Current smoking status by Gender [for those who have tried smoking].

Female Male

Tried smoking but dont smoke now 45 60 Smoke sometimes but not every week 22 18 Smoke between 1 and 4 a week 6 7 Smoke between 5 and 10 a week 7 7 Smoke more than 10 a week 20 9

[Chi-Square p = 0.002 Sample Size = 565 1 LI

Table 3.34 Current smoking status by Gender

Female Male

Non-smoker 61 74 Casual smoker 20 16 Regular smoker 19 10 ci [Chi-Square p = 0.000 Sample size = 786] ci

LI 112 ci Of those who have tried smoking more males (60%) than females (45%) stopped smoking within a few years. Twenty percent of females vs. nine percent of males smoked more than 10 cigarettes a week. Therefore, females tended to smoke more often in comparison with males aged 12-17 years of age.

Table 335 Current smoking status by Age

13 14 15 16 17

Never smoked 47 41 25 26 27 Tried smoking but dont smoke now 32 27 35 39 40 Smoke sometimes but not every week 11 15 15 14 12 Smoke between 1 and 4 a week 4 6 7 3 1 Smoke between 5 and 10 a week 3 5 4 5 7 Smoke more than 10 a week 5 7 15 14 12

[Chi-Square p = 0.000 Sample Size = 841] Again, the results reported for smoking history are repeated for current smoking status with the younger students more likely to have never smoked and the older students in our sample more likely to smoke 10 or more cigarettes, half a packet, a week.

Table 336 Current smoking status by Age [for those who have tried smoking].

13 14 15 16 17

Tried smokins but dont smoke now 59 45 46 53 55 Smoke sometimes but not every week 20 25 20 18 16 Smoke between 1 and 4 a week 7 9 9 4 2 Smoke between 5 and 10 a week 5 8 5 7 10 Smoke more than 10 a week 9 12 20 19 16

[Chi-Square p = 0.233 Sample Size = 561 ] There was no statistical significance in current smoking status between the age groups for those students who had indicated they had tried smoking.

113 U

Table 3.37 Current smoking status by Ethnic group [] Female Male [I

Non-smoker 56 68 Casual smoker 16 19 Regular smoker 28 13

[Chi-Square p = 0.000 ] Twice as many Maori smoke regularly than non-Maori, which was a statistically significant result.

Table 3.38 Current smoking status by Area

Ackhid Hawkes Bay Wgton Nelson Canty jJ

Non-smoker 74 57 70 66 69 Casual smoker 17 19 22 19 18 Regular smoker 10 24 8 16 13

[Chi-Square p = 0.002] U

There were three times more regular smokers in Hawkes Bay (the highest) than in Wellington (the lowest). U U Table 3.39 Current smoking status by Age: Females

12-13 14-15 16-17

Non-smoker 75 59 58 Casual smoker 16 24 16 Regular smoker 9 17 26 U

[Chi-Square p = 0.002 Sample Size = 482] U U 114 U Table 3.40 Current smoking status by Age: Males

12-13 14-15 16-17

Non-smoker 80 70 75 Casual smoker 13 18 14 Regular smoker 7 12 11

[Chi-Square p = 0.53 1 Sample Size = 334] In our sample, smoking clearly increased with age among females, but such an increase was not so apparent for males. As age increased females in our sample smoked more than males - the difference only became statistically significant in the 16-17 age group where more than twice as many females (26%) as males (11%) became "regular smokers".

Table 3.41 Current smoking status by Gender: Maori

Female Male

Non-smoker 45 73 Casual smoker 16 17 Regular smoker 39 10

[Chi-Square p = 0.002 Sample Size = 125]

Table 3.42 Current smoking status by Gender: NOn-Maori

Female Male

Non-smoker 65 74 Casual smoker 21 15 Regular smoker 14 10

[Chi-Square p = 0.037 Sample Size = 691]

115 [I In our sample, four times as many Maori females (39%) as Maori males (10%) were "regular smokers". Non-Maori female students reported they smoked significantly more than males, but the difference was relatively small. U Table 3.43 Current smoking status by Age: Maori

12-13 14-15 16-17

Non-smoker 64 45 66 Casual smoker 9 20 14 Regular smoker 27 36 21

[Chi-Square not valid Sample Size = 125] U Cl Table 3.44 Current smoking status by Age: Non-Maori

12-13 14-15 16-17

Non-smoker 78 67 65 Casual smoker 15 22 16 Regular smoker 6 11 20

[Chi-Square p 0.000 Sample Size = 691] In our sample, Maori in the 12-13 and particularly the 14-15 age groups smoked more than Non-Maori. However, in the 16-17 age group there was no significant U difference between the two ethnic groups.

Table 3.45 Current smoking status by Ethnic group : Females U Maori Non-Maori Cl Non-smoker 45 65 Casual smoker 16 21 Regular smoker 39 14

[Chi-Square p = 0.000 Sample Size = 482]

ci 116 Cl Of the female students in our sample, 55% of Maori and 35% of Non-Maori were current smokers. Thirty-nine percent of female Maori were "regular smokers" compared with only 14% of Non-Maori females.

Table 3.46 Current smoking status by Ethnic group : Males

Maori Non-Maori

Non-smoker 73 74 Casual smoker 17 15 Regular smoker 10 10

[Chi-Square p = 0.974 Sample Size = 334] For males in our sample, there was no difference in smoking behaviour between Maori and Non-Maori.

Table 3.47 Current smoking status by Area : Female

Aucklnd Hwkes Bay Wgton Nelson Canty

Non-smoker 67 52 69 62 61 Casual smoker 21 16 23 18 24 Regular smoker 13 32 8 20 15

[Chi-Square p = 0.002 Sample Size = 463]

Table 3.48 Current smoking status by Area: Male

Auckland Hawkes Bay Nelson Canty

Non-smoker 82 64 69 79 Casual smoker 12 23 20 10 Regular smoker 6 13 11 11

[Chi-Square not valid Sample Size = 326]

117

Again, as seen with smoking history, the Hawkes Bay sample contained the highest percentage of female students reporting to be regular smokers, with the Wellington sample having the lowest number of females reporting this. There was little difference in reported smoking behaviour between the regions for male students.

Table 3.49 Current smoking status by Area : Maori

Aucklnd Hwkes Bay Wgton Nelson Canty

Non-smoker 52 50 43 57 89 Casual smoker 19 16 29 14 11 Regular smoker 30 34 29 29 0

[Chi-Square not valid Sample Size = 129]

Table 3.50 Current smoking status by Area: Non-Maori

Auckind Hwkes Bay Wgton Nelson Canty

Non-smoker 77 60 73 66 67 Casual smoker 16 20 21 19 19 Regular smoker 7 20 5 14 15

[Chi-Square p = 0.009 Sample Size = 660]

Maori students from Auckland and Hawkes Bay were more likely to report they were regular smokers in comparison with their counterparts from Nelson and Canterbury. This result needs to be interpreted with some caution due to the small numbers of Maori in some of the regions sampled. There was some variability in smoking behaviours of Non-Maori students across the regions sampled. For example, 77 percent of Auckland Non-Maori students was categorised as non-smokers in comparison with 60 percent of the Non-Maori students in the Hawkes Bay sample.

118 Eli 3.4.4 In depth analysis of the Hawkes Bay student sample

The figures for the Table 3.38 indicate that the students in the Hawkes Bay sample had both the highest percentage of subjects who had tried smoking at least once (77%), and the highest percentage who had "Smoked lots of times (38%). Similarly, Table 3.38 shows that students in the Hawkes Bay sample contained the highest percentage of regular smokers (24%). The Hawkes Bay sample contained both the largest number of Maori subjects (71: 30%) and the largest number of female subjects (147: 57%), so it was decided to make a more detailed examination of the data for this area - both on its own and in comparison with the other areas.

Table 3.51 Smoking history by Area

Hawkes Bay Other areas

Never smoked 23 31 Tried smoking once 14 21 Smoked more than once 26 22 Smoked lots of times 37 26

[Chi-Square p =0.001 Sample Size = 839] There was a significant difference in smoking history between the students sampled in Hawkes Bay in comparison with students from the rest of the sample. Students in Hawkes Bay were less likely to report never having smoked and more likely to report having smoked lots of times.

Table 3.52 Smoking history by Area [for those who have tried smoking].

Hawkes Bay Other areas

Tried smoking once 18 30 Smoked more than once 34 32 Smoked lots of times 48 38

[CM-Square p = 0.005 Sample Size = 603]

119

II For those who had tried smoking, the Hawkes Bay sample were more likely to have smoked lots of times in comparison with the students from the rest of the sample. II

Table 3.53 Current smoking status by Area II

Hawkes Bay Other areas II

Non-smoker 58 70 II Casual smoker 19 18 Regular smoker 23 12 II [Chi-Square p = 0.000 Sample Size = 824] II The tables above clearly establish the significantly greater degree of smoking behaviour among the subjects in our Hawkes Bay sample in comparison with the other areas. Similar analyses for the "next highest smoking areas", Nelson and II Wellington, show no significant difference between these areas and the other areas combined (See Appendix 2 for these tables). II The following tables are intended to elucidate the factors which were responsible for the difference between our Hawkes Bay sample and the samples from other areas. II

Table 3.54 Smoking history by Area: Females II

II Hawkes Bay Other areas combined

II Never smoked 24 29 Tried smoking once 9 16 Smoked more than once 24 23 Smoked lots of times 44 31 A

[Chi-Square p =0.015 Sample Size = 480] II Females subjects in the Hawkes Bay sample smoked significantly more than female subjects in the other areas. 10 I A fi

120 III Table 3.55 Smoking history by Area: Males

Hawkes Bay Other areas combined

Never smoked 21 33 Tried smoking once 21 27 Smoked more than once 29 21 Smoked lots of times 28 20

[Chi-Square p = 0.035 Sample Size = 348] Males in the Hawkes Bay sample also smoked significantly more than males in the other areas, but the difference was not as great as that demonstrated for female students. For example, whereas 44 percent of Hawkes Bay female students reported smoking lots of times, only 28 percent of the Hawkes Bay males reported this degree of smoking history.

Table 3.56 Smoking history by [for those who had tried smoking] : Females

Hawkes Bay Other areas combined

Tried smoking once 11 23 Smoked more than once 32 33 Smoked lots of times 57 44

[Chi-Square p =0.014 Sample Size = 348] Of the females who had tried smoking once, significantly more in the Hawkes Bay sample went on to become regular smokers in comparison with female students from other areas.

Table 3.57 Smoking history by Area [for those who had tried smoking] : Males

Hawkes Bay Other areas combined

Tried smoking once 27 40 Smoked more than once 38 31 Smoked lots of times 35 30

[Chi-Square p = 0.150 Sample Size = 247]

121 These figures suggest that males in the Hawkes Bay sample smoked more than males in other areas, but the difference is not statistically significant. Thus, the gender difference between the Hawkes Bay students and the students from the rest of New Zealand is largely attributable to the smoking history of the Hawkes Bay female students.

Table 3.58 Current smoking status by Area : Females

Hawkes Bay Other areas combined

Non-smoker 53 65 Casual smoker 16 21 Regular smoker 31 14

[Chi-Square p 0.000 Sample Size = 475] More than twice as many females in the Hawkes Bay were regular smokers in comparison to other areas. This difference was highly significant and reinforced the comments made above.

Table 3.59 Current smoking status by Area : Males

Hawkes Bay Other areas combined

Non-smoker 65 79 Casual smoker 22 13 Regular smoker 13 9

[Chi-Square p = 0.023 Sample Size = 338 ] Significantly more males in the Hawkes Bay sample were smokers compared to other areas. However, the difference was smaller than that obtained for the female student comparison.

122 Table 3.60 Smoking history by Area: Maori

Hawkes Bay Other areas combined

Never smoked 15 16 Tried smoking once 14 21 Smoked more than once 25 31 Smoked lots of times 46 32

[Chi-Square p = 0.403 Sample Size = 134] It was considered that Maori in the Hawkes Bay sample may have smoked more than Maori in other areas, but the difference is not statistically significant. Therefore, the smoking behaviour of Maori students in the Hawkes Bay sample is no different from that of other Maori students sampled in our survey.

Table 3.61 Smoking history by Area : Non-Maori

Hawkes Bay Other areas combined

Never smoked 26 33 Tried smoking once 14 20 Smoked more than once 26 21 Smoked lots of times 35 26

[Chi-Square p = 0.015 Sample Size = 673] The Non-Maori in the Hawkes Bay sample smoked significantly more than Non- Maori in the other areas. Therefore, in terms of ethnicity, Non-Maori students were more likely to report they have smoked lots of times and less likely to report they have never smoked. Taken together with the findings for gender, it seems that female Non-Maori students smoking behaviour is higher in Hawkes Bay in comparison with their counterparts from the other sampled regions of New Zealand.

123 Table 3.62 Smoking history by Area [for those who had tried smoking] : Maori

Hawkes Bay Other areas combined

Tried smoking once 16 25 Smoked more than once 30 37 Smoked lots of times 54 38 [Chi-Square p = 0.234 Sample Size = 113] The figures suggest that of Maori who had tried smoking, more in the Hawkes Bay sample went on to become regular smokers, in comparison with Maori students from other regions, although the difference was not statistically significant.

Table 3.63 Smoking history by Area [for those who had tried smoking] : Non.. Maori

Hawkes Bay Other areas combined

Tried smoking once 18 30 Smoked more than once 35 32 Smoked lots of times 47 38

[Chi-Square p = 0.029 Sample Size = 467] Of the Non-Maori who had tried smoking, a significantly greater number in the Hawkes Bay sample became regular smokers compared to other areas.

Table 3.64 Smoking history by Area: Female Maori

Hawkes Bay Other areas

Never smoked 16 14 Tried smoking once 5 14 Smoked more than once 19 30 Smoked lots of times 60 43

[Chi-Square not valid Sample Size = 80]

124 iii Sixty percent of female Maori students in the Hawkes Bay sample reported smoking lots of time in comparison with their counterparts from other regions. Because of the small sample size Chi-Square was not a valid test of statistical significance for this result.

Table 3.65 Smoking history by Area: Female Non-Maori

Hawkes Bay Other areas

Never smoked 26 32 Tried smoking once 10 16 Smoked more than once 25 23 Smoked lots of times 39 29

[Chi-Square p = 0.161 Sample Size = 3881 There was no significance difference in smoking history reported by female Non- Maori Hawkes Bay students in comparison with their counterparts from other regions.

Table 3.66 Smoking history by Area: Male Maori

Hawkes Bay Other areas

Never smoked 14 20 Tried smoking once 28 32 Smoked more than once 34 32 Smoked lots of times 24 16

[Chi-Square not valid Sample Size = 54] Twenty-four percent of Maori males from Hawkes Bay reported having smoked lots of times in to 16 percent from other regions.

125 C) Table 3.67 Smoking history by Area : Male Non-Maori U Hawkes Bay Other areas C)

Never smoked 24 34 Tried smoking once 19 26 C) Smoked more than once 28 19 Smoked lots of times 30 21 C)

[Chi-Square p = 0.071 Sample Size = 282] There was no significant difference in reported smoking history between male Non-Maori students in Hawkes Bay in comparison with other areas.

Table 3.68 Smoking history by Area [for those who have tried smoking]: Female Maori

Hawkes Bay Other areas

Tried smoking once 6 16 Smoked more than once 22 34 Smoked lots of times 72 50

[Chi-Square not valid Sample Size = 68]

Whereas nearly three out of four female Maori Hawkes Bay students who have tried smoking reported smoking lots of times, only one in two female Maori U students from other regions reported the same thing. Only six percent of the female Maori students from Hawkes Bay who have tried smoking reported they have only tried smoking once. U U U C) U 126 C) Table 3.69 Smoking history by Area [for those who have tried smoking] : Female Non-Maori

Hawkes Bay Other areas

Tried smoking once 13 24 Smoked more than once 34 33 Smoked lots of times 53 43

[Chi-Square p = 0.136 Sample Size = 271] There was no statistically significant difference in the reported smoking history of female Non-Maori Hawkes Bay students in comparison with their counterparts from other regions.

Table 3.70 Smoking history by Area for those who have tried smoking Male Maori

Hawkes Bay Other areas

Tried smoking once 32 40 Smoked more than once 40 40 Smoked lots of times 28 20

[Chi-Square p = 0.782 Sample Size = 45] No significant difference.

Table 3.71 Smoking history by Area for those who have tried smoking Male Non-Maori

Hawkes Bay Other areas

Tried smoking once 25 39 Smoked more than once 36 29 Smoked lots of times 39 32

[Chi-Square p = 0.143 Sample Size = 194]

127 For both Maori and Non-Maori males in our Hawkes Bay sample there was no significant difference in smoking history in comparison with their counterparts from other regions.

Table 3.72 Current smoking status by Area : Maori

Hawkes Bay Other areas combined

Non-smoker 50 63 Casual smoker 16 17 Regular smoker 34 20

[Chi-Square p = 0.203 Sample Size = 129] The figures suggest that Maori in the Hawkes Bay sample smoked more than Maori in other areas, but the difference is not statistically significant.

Table 3.73 Current smoking status by Area: Non-Maori

Hawkes Bay Other areas combined

Non-smoker 60 71 Casual smoker 20 18 Regular smoker 20 11

[Chi-Square p = 0.004 Sample Size = 663 ]

A significantly greater number of Non-Maori in the Hawkes Bay sample smoked regularly compared to Non-Maori in other areas. Whereas 20 percent of Non- Maori Hawkes Bay students were categorised as regular smokers only 11 percent were for Non-Maori students from the other regions in our survey.

- 128

Table 3.74 Current smoking status by Area : Female Maori

Hawkes Bay Other areas

Non-smoker 44 46 Casual smoker 9 23 Regular smoker 47 31

[Chi-Square p = 0.181 Sample Size = 78]

No significant difference was found for current smoking of Hawkes Bay female Maori students in comparison with female Maori students from other regions.

Table 3.75 Current smoking status by Area: Female Non-Maori

Hawkes Bay Other areas

Non-smoker 56 67 Casual smoker 19 22 Regular smoker 25 11

[Chi-Square p = 0.003 Sample Size = 385 ] There was a significantly greater amount of smoking behaviour among the Non- Maori females in our Hawkes Bay sample in comparison with the other areas.

Table 3.76 Current smoking status by Area: Male Maori

Hawkes Bay Other areas

Non-smoker 59 88 Casual smoker 26 8 Regular smoker 15 4

[Chi-Square not valid Sample Size = 51]

129

Maori males from the Hawkes Bay sample were less likely (59%) to be categorised as non-smokers in comparison with other Maori males (88%).

Table 3.77 Current smoking status by Area: Male Non-Maori

Hawkes Bay Other areas

Non-smoker 65 77 Casual smoker 22 13 Regular smoker 13 10

Chi-Square p = 0.121 Sample Size = 275 1 While there was a significant difference in Non-Maori female current smoking status between Hawkes Bay and the rest of the sample, this result was not replicated for Non-Maori males.

Table 3.78 Smoking history by Ethnic group: Females in Hawkes Bay

Maori Non-Maori

Never smoked 16 26 Tried smoking once 5 10 Smoked more than once 19 25 60Smoked lots of times 39

[Chi-Square p = 0.114 Sample Size = 146] These figures suggest that Maori females smoked smoking more than Non-Maori females in the Hawkes Bay sample but the difference is not statistically significant.

130 III Table 3.79 Smoking history by Ethnic group: Males in Hawkes Bay

Maori Non-Maori

Never smoked 14 24 Tried smoking once 28 19 Smoked more than once 34 28 Smoked lots of times 24 30

[Chi-Square p = 0.494 Sample Size = 109] There was no difference in smoking history between Maori and Non-Maori males in Hawkes Bay.

Table 3.80 Smoking history by Ethnic group : Females in the Other areas

Maori Non-Maori

Never smoked 14 32 Tried smoking once 14 16 Smoked more than once 30 23 Smoked lots of times 43 29

[Chi-Square p = 0.092 Sample Size = 322] Again these figures are suggestive, but not statistically significant. Maori female students from the survey other than Hawkes Bay, were more likely to report having smoked lots of times (43%) in comparison with Non-Maori females (29%).

Table 3.81 Smoking history by Ethnic group : Males in the Other areas

Maori Non-Maori

Never smoked 20 34 Tried smoking once 32 26 Smoked more than once 32 19 Smoked lots of times 16 21

[Chi-Square p = 0.298 Sample Size = 227]

131 Maori and Non-Maori males reported similar smoking histories in the areas sampled other than Hawkes Bay. There was no significant difference in their reporting of smoking history.

Table 3.82 Smoking history by Ethnic group [excluding those who have never smoked]: Females in Hawkes Bay

Maori Non-Maori

Tried smoking once 6 13 Smoked more than once 22 34 Smoked lots of times 72 53

[Chi-Square p = 0.131 Sample Size = 112] The figures suggest that of females in the Hawkes Bay sample who tried smoking once, more Maori than Non-Maori went on to become regular smokers, but the difference is not statistically significant.

Table 3.83 Smoking history by Ethnic group [excluding those who have never smoked]: Males in Hawkes Bay

Maori Non-Maori

Tried smoking once 32 25 Smoked more than once 40 36 Smoked lots of times 28 39

[Chi-Square p = 0.585 Sample Size = 86] Again, there was no significant difference in smoking history between Maori and Non-Maori male students in the Hawkes Bay sample.

132

Table 3.84 Smoking history by Ethnic group [excluding those who have never smoked]: Females in Other areas

Maori Non-Maori

Tried smoking once 16 24 Smoked more than once 34 33 Smoked lots of times 50 43

[Chi-Square p = 0.582 Sample Size = 227] No significant difference.

Table 3.85 Smoking history by Ethnic group [excluding those who have never smoked]: Males in the Other areas

Maori Non-Maori

Tried smoking once 40 39 Smoked more than once 40 29 Smoked lots of times 20 32

[Chi-Square p = 0.491 Sample Size = 153] For both males and females of Maori and Non-Maori ethnic origin in our sample from other areas than Hawkes Bay, there was no significant difference in reported smoking history.

Table 3.86 Current smoking status by Ethnic group : Females in Hawkes Bay

Maori Non-Maori

Non-smoker 44 56 Casual smoker 9 19 Regular smoker 47 25

[Chi-Square p = 0.036 Sample Size = 145]

133 IJ Maori females in our Hawkes Bay sample smoked significantly more than Non- Maori females in Hawkes Bay.

Table 3.87 Current smoking status by Ethnic group : Males in Hawkes Bay [

Maori Non-Maori fl

Non-smoker 59 65 Casual smoker 26 22 Regular smoker 15 13

[Chi-Square p = 0.849 Sample Size = 105] There was no significant difference in current smoking status between Maori and n Non-Maori males from the Hawkes Bay sample.

Table 3.88 Current smoking status by Ethnic group : Females in the Other areas

Maori Non-Maori

Non-smoker 46 67 Casual smoker 23 22 Regular smoker 31 11

n [Chi-Square p = 0.003 Sample Size = 318 1 Female Maori students in other areas reported smoking significantly more than Non-Maori females in other areas.

Table 3.89 Current smoking status by Ethnic group : Males in the Other areas 9 9 Maori Non-Maori

ci Non-smoker 88 77 Casual smoker 8 13 Regular smoker 4 10

[Chi-Square not valid Sample Size = 221] [1 U 134 9 Summary Table Hawkes Bay findings (with statistical significance)

Females in HE smoked more than females in other areas p=O.000 Non-Maori in HE smoked more than Non-Maori in other areas p = 0.004 Non-Maori in BB smoked more than Non-Maori in other areas p=0.015 Non-Maori females in RB smoked more than Non-Maori females in Other Areas p =0.003 Males in RB smoked more than males in other areas p =0.035 Non-Maori males in RB smoked more than Non-Maori males in Other Areas p =0.071 Maori females in Other Areas smoke more than Non-Maori females in Other Areas p = 0.003 Maori females in RB smoked more than Non-Maori females in Hawkes Bay p =0.036

Conclusion

Subjects of both genders and both ethnic groups smoked more in the Hawkes Bay sample than in the other areas combined, although not all differences reached statistical significance. These differences may be attributable to the geographic location, but could just as easily be the result of differences in the socio-economic status of the schools catchment areas or even the result of non-homogeneous selection procedures for students between one school and another.

135

3.4.5 Source and availability of cigarettes

Question III: Source of cigarettes for smokers

Instruction: "If you smoke, where do you get your cigarettes from? You may need to tick more than one box- "

No. of respondents = 659 No. of non-smokers = 289 No. of smokers = 370

Table 3.90 Source of cigarettes

SOURCE N % (of smokers)

Buy them at dairies 236 63.8 From friends 226 61.1 Buy at service stations 142 38.4 Buy at other shops 128 34.6 Buy them at supermarkets 106 28.6 Other buys for me 75 20.3 Steal them 65 17.6 From mother or father 63 17.0 From siblings 60 16.2 From a slot machine 35 9.5 13"Find" them 3.5 Some other source 37 10.0

The N values are the total responses made by each student for each alternative answer. As a student could make multiple responses, the sum of the N values is greater than the sum of the students, that is, sample size.

The percent values shown represent the number of responses for each category/answer divided by the number of respondents who answered this question. For example, for the "buy them at dairies", 236 of the 370 students ticked this option giving a percent value of 63.8. So 63.8 of the sample who responded (whosmoke) reported they purchased their cigarettes from dairies. Buying from a shop, [dairy (63.8%), service station (38.4%) and supermarket (28.6%)] and obtaining them from friends (6 1.1%) are the main ways students in our sample reported obtaining their cigarettes.

136 Using family members, father/mother (17%) or brothers/sisters (16.2%) or getting someone else to purchase them (20.3%) are other methods used to obtain cigarettes. A revealing 17.6 percent of the respondents indicated they stole the cigarettes.

For the purposes of comparison with the National Research Bureau (NRB) surveys (1989, 1991) these cigarette sources were combined as follows:

No. of respondents = 659 No. of non-smokers = 289 No. of smokers = 370

Table 3.91 Source of cigarettes using combined categories

SOURCE N % (of smokers) NRB (89/91) % (of smokers)

Buy them from a shop 244 65.9 67/65 From friends 226 61.1 63/73 Someone else buys them for me 75 20.3 28/35 From mother or father 63 17.0 14/30 From brother or sister 60 16.2 16/14 From a slot machine 35 9.5 3/6 Some other way 102 27.6 3/0

The majority of subjects in our sample either purchased their cigarettes themselves or obtained them from friends which is consistent with the previous findings reported by the NRB. Our results closely relate to previous surveys, except there appears to be an increasing use of slot machines from 3% use in 1989 to 9% use in 1993. Clearly, either the availability of slot machines has increased for the 12-17 age group or they are now being seen as a readily available source of cigarettes which may not have been the case in the past. Also another noticeable rise from previous surveys is the category of "some other way". In the 1989 NRB survey this category didnt feature at all (0%), in the 1991 NRB survey it was three percent of the respondent and in our sample 27.6 percent were categorised as obtaining their cigarettes in this way. This maybe an artefact of the way we and NRB asked this question or it maybe that 12-17 year olds are using a greater variety of methods to obtain cigarettes. Stealing has already been mentioned as one possible increasing avenue that cigarettes are being obtained by this age group.

137

Table 3.92 Cigarette Source by Gender

Female Male

Buy them from a shop 54 40 (% of smokers) From friends 52 34 Someone else buys them for me 15 14 From mother or father 16 8 From brother or sister 15 8 From a slot machine 6 9

Female students (54%) are more likely to purchase cigarettes from a shop in comparison with male students (40%). Half the female students obtain cigarettes from friends while a third of male students obtain their cigarettes in this way.

Table 3.93 Source of Cigarettes by Age

12-13 14-15 16-17

Buy them from a shop 32 49 57 (% of smokers) From friends 43 47 44 Someone else buys them for me 19 15 12 From mother or father 5 15 15 From brother or sister 9 12 13 From a slot machine 7 6 8

As expected, the number of subjects purchasing their cigarettes from a shop increased from 32% for the 12-13 age group to 57% for the 16-17 age group. Children in the younger age group were less likely to obtain cigarettes from their parents. It is illegal for students under the age of 16 years to purchase cigarettes from a retail outlet, yet our results would indicate that for a third of 12-13 year olds and half the 14-15 year olds, thus the legislation seems to pose no barriers to the purchase of cigarettes for 12-15 year old students. Given our respondents were

138

-. ------school children, one might also assume that some purchases would be made while they are in school uniform.

Table 3.94 Source of Cigarettes by Ethnic Group

Maori Non-Maori

Buy them from a shop 64 46 (% of smokers) From friends 51 44 Someone else buys them for me 17 14 From mother or father 25 10 From brother or sister 24 9 From a slot machine 8 7

Maori students (64%) were more likely to purchase cigarettes from a shop in comparison with Non-Maori students (46%). Maori students (25%) were more likely to ask their parents for cigarettes in comparison to Non-Maori students (10%). Overall, more Maori students reported a variety of methods to obtain cigarettes while Non-Maori students reported obtaining cigarettes from a shop or friends.

3.4.6 Brand awareness of the sample

Question IV: Known brands of cigarettes (Brand Awareness)

Instruction: Write down all the brand names of cigarettes that you know the names of"

Cigarette brand awareness of the sample is presented in Table 3.95 on the next page. When asked to write down all the brand names of cigarettes they could recall, the main brands students recalled were Winfield (76.2% of respondents), Pall Mall (7501o), Benson & Hedges (58.5%), Rothmans (56.4), Holiday (42.6%), Peter Jackson (40%) and John Brandon (30.5%).

139 Table 3.95 Cigarette brand awareness

Brand N %

Winfield 522 76.2 Pall Mall 514 75.0 Benson & Hedges 401 58.5 Rothmans 386 56.4 Holiday 292 42.6 Peter Jackson 274 40.0 John Brandon 209 30.5 Camel 117 17.1 Marlboro 102 14.9 Dunhill 92 13.4 Peter Stuyvesant 85 12.4 Sportsman 77 11.2 Pacific 68 9.9 Fleur 67 9.8 Other brand(s) 45 6.6 Cameo 43 6.3 Too many to detail 41 6.0 More 34 5.0 Longbeach 26 3.8 Casino 26 3.8 Alpine 17 2.5 Slim 15 2.2 Topaz 14 2.0 Salem 12 1.8 Sobranie 10 1.5 Winston 9 1.3 Lucky Strike 9 1.3 North Pole 8 1.2 Superlights 6 0.9 San Remo 6 0.9 John Player 6 0.9 Philip Morris 1 0.1 Mild Seven 0 0.0 Kent 0 0.0

[No. of respondents = 685]

It is of significance to note that the major cigarette brands recalled by the 12-17 sample are also the main brands that sell and are the main brands associated with major tobacco sponsorships. For example, ranking cigarette brands according to 1991 sales figures you obtain the following order which is presented in Table 3.96 below.

140 9 Table 3.96 Cigarette brand sales 1991 and brand awareness

Brand Manufacturer No. sold in 1991 Sample awareness ranking

Winfield Rothmans 1,015,646 1

Pall Mall Rothmans 768,895 2

Benson & Hedges WD & HO Wills 519,866 3

TIII.ubs11 Rothmans 471,932 4

Peter Jackson WD & HO Wills 414,595 6

John Brandon Rothmans 138,997 7

The ranking of sales and awareness was identical except the Holiday brand was recalled more often than Peter Jackson and John Brandon. It is clear there is a strong association between brand awareness and the sale of cigarettes in our 12-17 year old sample. These same cigarette brands are also involved with major sponsorships which is examined later in this section. The seven brands Winfield, Pall Mall, Benson & Hedges, Rothmans, Holiday, Peter Jackson and John Brandon rated highest in terms of both Brand Awareness and Brand Preference (next question) were selected for more detailed analysis.

Table 3.97 Brand Awareness by Gender

Female Male

Pall Mall 81 67 Winfield 76 77 Benson & Hedges 61 56 Rothmans 59 55 Holiday 50 32 Peter Jackson 41 42 John Brandon 38 22 Marlboro 10 23

141

Brand awareness of Pall Mall, Holiday and John Brandon were higher for females. Awareness of Marlboro was highest for males (not surprisingly given the "macho male" image projected by Marlboro advertising).

Table 3.98 Brand Awareness by Age

12-13 14-15 16-17

Pall Mall 75 74 78 Winfield 74 78 76 Benson & Hedges 63 56 60 Rothmans 52 55 63 Peter Jackson 38 41 44 Holiday 38 46 44 Marlboro, 20 12 14 John Brandon 19 35 35

The younger age group mentioned Marlboro more and John Brandon less than the older age groups. The two well known brands, Winfield and Pall Mall were recalled by approximately three out of four students from all age groups, that is, by 12-13, 14-15 and 16-17 year olds.

Table 3.99 Brand Awareness by Ethnic group

Maori Non-Maori

89Pall Mall 73 Winfield 82 76 Rothmans 67 56 Benson & Hedges 48 61 Holiday 46 43 Peter Jackson 42 41 John Brandon 35 31 Marlboro 3 17

Pall Mall, Winfield, and Rothmans were mentioned more often by Maori subjects, Benson & Hedges and Marlboro more often by Non-Maori subjects.

142 Table 3.100 Brand Awareness by Area

Auckland Hawkes Bay Wgton Nelson Canty

Winfield 70 79 83 75 64 Pall Mall 70 79 82 65 80 Benson & Hedges 61 62 52 53 78 Rothmans 55 61 57 53 64 Peter Jackson 38 44 46 39 31 Holiday 38 40 51 38 51 John Brandon 18 40 39 26 31 Marlboro 15 17 12 13 24

Cigarette brand recall for Winfield and Pall Mall was highest for Wellington students followed by Hawkes Bay and Canterbury students. In the NRB 1991 survey, respondents were asked if they could recall seeing any cigarette name promoted on TV in the last year. The brands recalled were: Winfield (16%), Rothmans (13%), Benson & Hedges (12%), Pall Mall 5%) and Peter Jackson (3%). The rank order of recall in the NRB survey was very similar to the order reported by our sample.

3.4.7 Cigarette brand preference of the sample

Question V: Brand usually smoked (Brand preference)

We have used the term "brand preference "for ?rand usually smoked acknowledging that this may not be a preference based on "taste" alone.

Instruction: If you smoke, what brand of cigarettes do you usually smoke?" The results for cigarette brand preference are presented in Table 3.101 belqw. Pall Mall and Winfield were the two brands most preferred. Winfield are available in packets of 25 and Pall Mall in packets of 10 which may contribute to their popularity in each case. It might have been useful to inquire about the number of cigarettes purchased at point of sale - including a question about the availability of and preference for cigarettes sold-singly. For example, future surveys should ask a question like, "If you purchase cigarettes from a shop, what pack size do you most often buy, single cigarettes, lOs, 14s, 15s, 20s, 25s, 30s, or roll your owns? Also there is no information about the strength of the cigarettes preferred e.g. No filter / filter mild / extra mild etc. which might have a bearing on choice.

143 Table 3.101 Cigarette brand preference No. of respondents = 806 No. of smokers = 255

Brand % (of smokers)

Pall Mall 68 26.7 Winfield 66 25.9 Benson & Hedges 38 14.9 Too many to detail 37 14.5 Rothmans 33 12.9 Tobacco 26 10.2 Holiday 25 9.8 John Brandon 23 9.0 Peter Jackson 17 6.7 Dunhill 11 4.3 Drugs 9 3.5 Marlboro 6 2.4 Sportsman 4 1.6 Alpine 3 1.2 Camel 2 0.8 Pacific 2 0.8 Cameo 1 0.4 Fleur 1 0.4 Lucky Strike 1 0.4 No usual brand 1 0.4 Other brand(s) 1 0.4 Salem 1 0.4 Superlights 1 0.4 Casino 0 0.0 Cigars 0 0.0 John Player 0 0.0 Kent 0 0.0 Longbeach 0 0.0 Mild Seven 0 0.0 More 0 0.0 North Pole 0 0.0 Peter Stuyvesant 0 0.0 Phillip Morris 0 0.0 San Remo, 0 0.0 Slim 0 0.0 Sobranie 0 0.0 Topaz 0 0.0 Winston 0 0.0

Again, cigarette brand preference is also closely linked to cigarette sales and sponsorship. The cigarette brands that sold the most were also the more preferred by our sample of 12-17 year olds. Again our survey has shown that 12-17 year old

144

students choose the most sponsored brands to smoke. As noted by a Smoke-free Times article (Smokefree Times, 1992B): ...sponsors are prepared to spend large sums because they recover their expenditure through increased sales - and the image of thefr products is enhanced by the association with sport and success.

Table 3.102 Brand Preference by Gender

Female Male (% of smokers) (% of smokers)

34Pall Mall 16 Winfield 24 30 Rothmans 15 10 Benson & Hedges 13 17 Holiday 12 7 John Brandon 11 6 Peter Jackson 9 4 Marlboro 1 6

More females (34% of smokers) than males (16%) preferred Pall Mall. More males (6%) than females (1%) preferred Marlboro.

Table 3.103 Brand Preference by Age

12-13 14-15 16-17

Winfield 23 28 24 Pall Mall 23 27 30 Benson & Hedges 16 15 14 Peter Jackson 10 12 16 Holiday 10 15 6 Marlboro 6 1 3 Jackson 6 6 9 John Brandon 3 11 10

More than 10 percent of the 12-13 and 14-15 year olds reported a brand preference for five of the eight main cigarette brands, indicating some experimentation with smoking different cigarette brands at these ages. Also, while only three percent of 12-13 year olds reported a brand preference for John Brandon, eleven percent of

145

the 14-15 and ten percent of the 15-16 year olds indicated a preference for this brand. It is interesting to note that for the two most popular brands, Winfield and Pall Mall, a brand preference for these cigarettes is evident in the 12-13 year old students. So even at this early age, decisions have been made about which brands of cigarettes are "better" to smoke in comparison with other brands.

Table 3.104 Brand Preference by Ethnic Group

Maori Non-Maori

Pall Mall 36 25 Winfield 30 25 Rothmans 25 10 Holiday 11 10 Peter Jackson 6 8 John Brandon 4 11 Benson & Hedges 2 18 Marlboro 0 3

Benson & Hedges was identified as the preferred brand by nine times as many Non-Maori (18%) as Maori (2%). For Pall Mall (36%) and Winfield (30%) more Maori in comparison with Non-Maori (25%, 25%, respectively) preferred these cigarette brands.

Table 3.105 Brand Preference by Area

Auckland Hawkes Bay Wgton Nelson Canty

Winfield 27 29 7 32 21 Rothmans 17 12 13 18 10 Pall Mall 17 28 67 32 3 Benson & Hedges 14 8 20 18 25 Holiday 12 11 13 18 4 Peter Jackson 10 4 0 11 10 John Brandon 7 27 0 15 Marlboro 0 0 0 11 6

Less subjects in the Wellington sample identified Winfield as their preferred brand in comparison with the other areas. Conversely more Wellington subjects

146 preferred Pall Mall than in other areas. The Wellington sample is female only and this needs to be remembered when interpreting these cigarette brand preference differences.

3.4.8 Reason for brand preference

Question VI. Why smoke usual brand? (Reason for Brand Preference)

Instruction: If you usually smoke one brand of cigarettes, why do you? Tick all that apply.

No. of respondents = 773 No. who smoke = 317

Table 3.106 Reason for brand preference

N %

I like the taste 174 54.9 They are the cheapest 66 20.8 Associated with sporting event 15 4.7 Associated with non-sporting event 10 3.2 I have no brand preference 140 44.2

Taste was identified as the main reason for brand preference by 55% of the sample followed by price (21%). Forty-four percent of the respondents had no brand preference. Association of the preferred brand with either a sporting or non- sporting event was cited as the reason for brand preference by only 3-5% of the sample. Thus, taste and price were the main considerations given by the respondents for smoking a particular brand of cigarettes.

Table 3.107 Reason for Brand Preference by Gender

Female Male

I like the taste 56 54 They are the cheapest 24 15 I have no Brand Preference 43 43

147 U Females were more likely than males to cite price as a reason for brand preference. []

Table 3.108 Reason for Brand Preference by Age

12-13 14-15 16-17

I like the taste 41 57 58 (% of smokers) They are the cheapest 17 20 24 I have no brand preference 65 41 37 U Subjects recording no brand preference declined from 65% in the 12-13 age group to 37% in the 16-17 age group. Older subjects were more likely to cite taste as the reason for brand preference.

Table 3.109 Reason for Brand Preference by Ethnic group

Maori Non-Maori

I like the taste 60 54 (% of smokers) They are the cheapest 23 21 I have no Brand Preference 40 44

There were no differences in reason for brand preference between ethnic groups. U Table 3.110 Reason for Brand Preference by Area fl Auckland Hawkes Bay Wgton Nelson Canty U

I like the taste 53 56 52 65 57 They are the cheapest 24 25 19 15 19 11 I have no Brand Preference 45 40 45 38 43 (1 There were no marked differences in reason for brand preference between the - samples in different areas. Again, taste was by far the significant factor used by the respondents to determine what cigarette brand they wanted to smoke, followed by price. U U 148

3.4.9 Cigarette brand sponsorship of sporting activities/events

Question VII: Brands associated with sport

Instruction: "Below is a list of sporting events that are sponsored by cigarette companies. Please write down the cigarette brand name associated with each sporting event."

Table 3.111 Brands associated with Rugby League

N % (of respondents)

Winfield 418 96.5 Rothmans 9 2.1 Benson & Hedges 3 0.7 Sobranie 2 0.5 Marlboro 2 0.5 John Brandon 2 0.5 Pall Mall 1 0.2 Other brand(s) 1 0.2

[No. of respondents = 433] 418 subjects (47%) associated Winfield with Rugby League. Winfield is the major sponsor of the Australian Premier Rugby League Championship which receives saturation television coverage in New Zealand.

Table 3.112 Brands associated with Tennis

N % (of respondents)

Benson & Hedges 229 86.7 Rothmans 22 8.3 Winfield 9 3.4 John Brandon 3 1.1 Sportsman 2 0.8 Peter Jackson 1 0.4 Holiday 1 0.4

[No. of respondents = 264]

149 229 subjects (26%) associated Benson & Hedges with tennis. Benson & Hedges sponsors an annual international mens tennis tournament (the Benson & Hedges Open) in Auckland during summer. Last summer this was associated with an intensive advertising campaign focusing on the "Benson and Hedges This Summer Dreams turn to Gold" promotion (see Figure 3.1). Posters were displayed in retail outlets with this message.

Table 3.113 Brands associated with Softball

N % (of respondents)

Winfield 77 82.8 Rothmans 6 6.5 Peter Jackson 6 6.5 Pall Mall 2 2.2 Marlboro 2 2.2 Casino 1 1.1 Benson & Hedges 1 1.1

[No. of respondents 93] 77 subjects (9%) associated Winfield with softball. Winfield has sponsored softball series featuring the New Zealand national mens and womens teams, as well as the mens and womens softball championships since 1963.

Table 3.114 Brands associated with Car Rallying

N % (of respondents)

Rothmans 199 79.9 Peter Jackson 20 8.0 Winfield 13 5.2 Benson & Hedges 10 4.0 Pall Mall 4 1.6 Marlboro 4 1.6 Camel 2 0.8 Tobacco 1 0.4 Pacific 1 0.4 John Brandon 1 0.4

[No. of respondents = 249]

150 I1gure 3.1 Benson & Hedges Sports Sponsorship Poster

BI TSO1 T )

This Summer Dreams Thrn To Gold Two big events of a golden Summer on & lIED GES national television

OPEN TENNIS One of the annual highli ghts of the New Zealand sporting calendar, this year with an even more superb quality of entry. As serve meets smash, aces battle volleys. New Zealand will be watching - live!.

ONE World of Sport January 11-17

BENSON & lIED GES WORLD SERIES CRICKET

Another firm viewer favourite. The excitement continues this year from Australia, and although "our" boys wont be there, a feast of one-day cricket action is certain. One thing that is less certain is whether the Australians will make the final against the West Indies and Pakistan!

TV3 November 29 - January 10 151 II 199 subjects (22%) associated Rothmans with car rallying. Rothmans has sponsored the New Zealand car rally series known as the Rothmans Rally of New II Zealand since 1988. II Table 3.115 Brands associated with Cycling II N % (of respondents) I Rothmans 10 47.6 Benson & Hedges 4 19.0 Winfield 2 9.5 II Peter Jackson 2 9.5 Pall Mall 2 9.5 Marlboro 1 4.8 II ii [No. of respondents = 21] 10 subjects (1% of the sample associated Rothmans with Cycling. Rothmans II sponsors cycling in New Zealand, for example, the Cycle Tour of Southland (since 1966) and the Cycle Classic (Waikato) from 1990. II Table 3.116 Brands associated with Soccer II

N % II

Winfield 109 87.2 (of respondents) [Ii Pall Mall 5 4.0 Rothmans 4 3.2 Benson & Hedges 3 2.4 Peter Jackson 1 0.8 11 Marlboro 1 0.8 Holiday 1 0.8 Camel 1 0.8 II [No. of respondents = 125] El 109 subjects (12% of the sample) associated Winfield with soccer. Winfield has sponsored the soccer provincial championship (from 1990), the Winfield Challenge Shield (from 1988) and the Winfield Trans-Tasman Soccer Cup (from 1986). III Rothmans has also sponsored soccer, the National League from 1970 - 1986. II A

152 11 Table 3.117 Brands associated with Motor car racing

% (of respondents)

Rothmans 105 40.4 Peter Jackson 81 31.2 Winfield 38 14.6 Benson & Hedges 25 9.6 Marlboro 23 8.8 Camel 7 2.7 Pall Mall 6 2.3 Longbeach 1 0.4 John Brandon 1 0.4 Holiday 1 0.4

[No. of respondents = 260]

105 subjects (25%) of the sample associated Rothmans with motor car racing. A further 81 subjects (12% of the sample) associated Peter Jackson with Motor racing. The Peter Jackson motor racing series is undertaken annually during summer throughout New Zealand. Benson & Hedges has also been associated with motor racing sponsorship since 1963.

Table 3.118 Brands associated with Motor cycle racing

N % (of respondents)

Rothmans 48 46.2 Winfield 20 19.2 Peter Jackson 14 13.5 Marlboro 13 12.5 Benson & Hedges 8 7.7 John Brandon 2 1.9 Camel 2 1.9 Tobacco 1 1.0 Pall Mall 1 1.0 Lucky Strike 1 1.0 Holiday 1 1.0

[No. of respondents = 104] 48 subjects (5% of the sample) associated Rothmans with motor cycle racing. Rothmans has sponsored the Round the World Superbike Championships since

153

....------. 1988. With motor racing sports, it is not uncommon to see the sponsors logo and design painted oncars or motor cycles. Indeed, motor cycles look like cigarette packets going around the track. Of course, this is the desired effect and makes recall of the sponsor, not to mention the glamourisation of the cigarette brand, all the more easy to remember.

Table 3.119 Brands associated with Harness racing

N % (of respondents)

Benson & Hedges 15 48.4 Winfield 9 29.0 Rothmans 5 16.1 Pall Mall 1 3.2 Tobacco 1 3.2

[No. of respondents = 31] 15 subjects (2% of the sample) associated Benson & Hedges with motor cycle racing. John Brandon (John Brandon 30 triple crown) in Christchurch, Winfield in Dunedin and Benson & Hedges (2 year old trotting) have sponsored harness racing events. One might expect that harness racing does not hold the attraction for the 12-17 year age group it does with older New Zealanders, yet this age group are able to accurately recall the cigarette company/brand name sponsors associated with harness racing.

Table 3.120 Brands associated with Gallops

N % (of respondents)

Benson & Hedges 12 52.2 Rothmans 5 21.7 Winfield 2 8.7 Holiday 1 4.3 Tobacco 1 4.3

[No. of respondents = 23]

12 subjects (1%) of the sample associated Benson & Hedges with gallops. Benson & Hedges has sponsored major gallops carnivals and races in both Auckland and

154 Wellington, such as, the Benson & Hedges Gold Cup (since 1972) and the John Brandon 30 Trophy race (since 1988).

Table 3.121 Brands associated with Various Sports (Aggregate)

N % (of respondents)

Winfield 441 84.8 Benson & Hedges 250 48.1 Rothmans 234 45.0 Peter Jackson 41 7.9 Marlboro 19 3.7 Pall Mall 15 2.9 John Brandon 7 1.3 Camel 5 1.0 Holiday 4 0.8 Sobranie 2 0.4 Sportsman 2 0.4 Tobacco 2 0.4 Casino 1 0.2 Lucky Strike 1 0.2 Other brand(s) 1 0.2 Pacific 1 0.2 Alpine 0 0.0 Cameo 0 0.0 Dunhill 0 0.0 Fleur 0 0.0 John Player 0 0.0 Kent 0 0.0 Longbeach 0 0.0 Mild Seven 0 0.0 More 0 0.0 North Pole 0 0.0 Peter Stuyvesant 0 0.0 Philip Morris 0 0.0 Salem 0 0.0 San Remo 0 0.0 Slim 0 0.0 Superlights 0 0.0 Topaz 0 0.0 Winston 0 0.0

[No. of respondents = 520]

In our sample only three brands were significantly associated with sporting events. These were Winfield, associated with rugby league, soccer and softball, Benson & Hedges, associated with Tennis, and Rothmans, associated with car rallying and both motor cycle and racing.

155

Table 3.122 Brand Association with Sports by Gender

Female Male

Winfield 55 74 (% of respondents) Benson & Hedges 31 45 Rothmans 27 48 Peter Jackson 7 8 Pall Mall 3 2 Marlboro 1 5 John Brandon 1 1 Holiday 0 2

More male in comparison with female students identified cigarette brand sponsorships with sports activities or events. Half the females and three-quarters of the males identified Winfield as a major sponsor of sports. This was followed by Benson & Hedges and Rothmans.

Table 3.123 Brand Association with Sports by Age

12-13 14-15 16-17

60Winfield 59 68 36Rothmans 35 36 Benson & Hedges 33 37 40 Peter Jackson 3 9 7 Marlboro 3 2 3 Pall Mall 0 3 3 John Brandon 0 2 1 Holiday 0 1 1

Over half of all age groups identified Winfield as a major sports sponsor. Nearly as many 12-13 year olds as 16-17 year olds identified the three major sponsors, namely, Winfield, Rothmans and Benson & Hedges. This indicates by the age of 12-13 years, children have a pretty good idea of what tobacco companies and cigarette brands are sponsoring sports events and activities. Given this, it would seem that sports sponsorship is a very powerful marketing weapon that captures individuals from an early age.

156

Table 3.124 Brand Association with Sports by Ethnic Group

Maori Non-Maori

Winfield 57 64 39Benson & Hedges 37 Rothmans 31 36 8Peter Jackson 7 Pall Mall 6 2 Marlboro 1 3 John Brandon 0 1 Holiday 0 1

There was very little difference in brand association with sports between Maori and Non-Maori students. The same relationships were evident for both ethnic groups of 12-17 year olds.

Table 3.125 Brand Association with Sports by Area

Auckland Hawkes Bay Wgton Nelson Canty

Winfield 43 54 30 54 60 Benson & Hedges 34 27 25 16 33 Rothmans 24 30 14 29 28 Peter Jackson 3 6 6 5 5 Pall Mall 2 3 0 0 1 Marlboro 2 1 0 2 4 John Brandon 0 1 0 0 2 Holiday 0 1 0 0 1

Again, the three main players, Winfield, Benson & Hedges and Rothmans were equally associated with sports across all the regions sampled in our survey. The blanket marketing strategy has clearly impacted on students throughout New Zealand. Given the top six cigarette brands in terms of sales, awareness and preference are manufactured by either Rothmans or WD & HO Wills, and provided they maintain their market share, there is no need to enhance the association of their lesser known brands with sponsorship of sports events. At present Rothmans with a 80% share and WD & HO Wills with a 20% share dominate the tobacco market in New Zealand.

157 3.4.10 Sports recalled as being "Smoke-free" sponsored Question VIII: Sports known to be smoke-free sponsored Instruction: "Please write down the name of any sports you know which are smoke-free sponsored:"

No. of respondents = 518 The students recall of sports thought to be Smoke-free sponsored are presented in table 3.126 below. A list of Smoke-free Lifespan sponsored sports events and teams undertaken by the Health Sponsorship Council (1991/92) is presented in Appendix 6.

Table 3.126 Sports recalled as being smoke-free sponsored

Sport N % (of respondents)

Netball 273 52.7 Basketball 170 32.8 Touch rugby 47 9.1 Volleyball 33 6.4 Hockey 32 6.2 Rugby league 31 6.0 Swimming 24 4.6 Softball 21 4.1 Rugby 18 3.5 Soccer 13 2.5 Cricket 12 2.3 Tennis 12 2.3 Judo 11 2.1 Gymnastics 8 1.5 Triathalons/marathons 8 1.5 Horse riding - racing - equestrian 7 1.4 Running - athletics 7 1.4 Squash 7 1.4 Surfing 7 1.4 Aerobics champs 5 1.0 Cycling 5 1.0 Golf 5 1.0 Yachting - Whitbread 5 1.0 Baseball 4 0.8 Motor car racing 3 0.6 Theatre sports 3 0.6 Badminton 2 0.4 Motor cycle racing 2 0.4 Car rallying 1 0.2 Fencing 1 0.2 Gallops 1 0.2 Harness racing 1 0.2

158

- - - - - 273 subjects(31% of the sample) believed Netball to be smoke-free sponsored. 170 subjects (19% of the sample) believed Basketball to be smoke-free sponsored. Smoke-free is a major sponsor of the following sporting events/activities: netball, volleyball (Christchurch), touch rugby, and basketball (Auckland).

3.4.11 Non-sporting events recalled to be smoke-free sponsored

Question IX: Non-sporting events known to be smoke-free sponsored

Instruction: "Please write down the name of any non-sporting (e.g. fashion, entertainment, recreation) events you know which are smoke-free sponsored:" No. of respondents = 110

Table 3.127 Non-sporting events recalled to be smoke-free sponsored

Event % (of respondents)

Rockquest 33 30.0 Fashion shows - awards 13 11.8 Battle of the bands 6 5.5 Music bands 6 5.5 Rap team 5 4.5 Theatre sports 4 3.6 Dances - dance groups 3 2.7 Music industry/music awards 3 2.7 Smoke-free music competition 3 2.7 Strip shows 3 2.7 TV programmes 3 2.7 Heaps! 2 1.8 Maori culture groups 2 1.8 Tramping 2 1.8 Youth for Christ 2 1.8 Ballroom dancing 1 0.9 Campus life 1 0.9 Drama 1 0.9 Facial dbx 1 0.9 Lip synch 1 0.9 Models 1 0.9 N ZSymphony Orchestra 1 0.9 Outward bound 1 0.9 Rock challenge 1 0.9 Singers performing at school 1 0.9 Water front challenge 1 0.9 Youth to youth smoke-free 1 0.9

159

33 subjects (4% of the sample) believed Rockquest to be smoke-free sponsored. 13 subjects (1% of the sample) believed Fashion shows/awards to be smoke-free sponsored. Smoke-free sponsorship has been associated with theatre and dance, such as, rockquest, theatre-sports, and dance and theatre companies.

3.4.12 Cigarette company sponsorship of non-sporting events

Question X: Non-sports events known to be sponsored by cigarette companies

Instruction: "Please write down the name of any non-sporting (e.g. fashion, entertainment, recreation) events you know which are sponsored by cigarette companies:"

No. of respondents = 246

Table 3.128 Non-sporting events recalled to be cigarette company sponsored

Event N % (of respondents)

Benson & Hedges fashion awards 210 85.4 23Fashion - awards 9.3 TV shows 4 1.6 Rockquest 3 1.2 Models 2 0.8 Actors 1 0.4 Aerobics 1 0.4 Annual smoke-free drive 1 0.4 Corbans fashion design 1 0.4 Dance - dance groups 1 0.4 Gay & lesbian festival 1 0.4 Heaps! 1 0.4 Lip synch 1 0.4 Miss N.Z. show 1 0.4 Popular people 1 0.4 Skating 1 0.4 Ten pin bowling 1 0.4

210 subjects (24% of the sample) knew that Benson & Hedges sponsored fashion awards. Apart from the annual fashion awards sponsorship, it appears that sponsorship of non-sports events has less impact on 12-17 year olds in comparison to the sponsorship of sports events.

160 3.4.13 Correlational analysis of brand awareness, brand preference and brand association with sport.

The results of a correlational analysis undertaken to determine if any association exists between brand awareness and preference and brand association with sport in our sample of 12-17 year old students is presented in table 3.129 below.

Table 3.129 Pearson correlations between: Brand Awareness, Brand Preference and Brand Association with Sport

Brand Brand Sport Awareness Preference Association

Brand Awareness 0.96 0.73 [P=0.0001] [p = 0.00011

Brand Preference 0.96 0.72 [P=0.00011 [P=0.0001]

Sport 0.73 0.72 Association [p =0.0001] [p=0.0001]

There were highly significant correlations between all three variables. The highest is between Brand Awareness and Brand Preference. These correlations indicate that there exists with this sample of 12-17 year old students very strong and significant relationship between brand awareness, preference and association with sports sponsorship. To put it another, there is a strong relationship between sports sponsorship, brand awareness and brand preference to the extent that one might extrapolate these findings to conclude that sports sponsorship is a major factor producing awareness of cigarette brands and influencing brand preference in our sample of 12-17 year old students.

161 3.5 Summary

A sample of 890 school children between the ages of 12 and 17 years from 14 schools around New Zealand took part in a questionnaire survey of smoking behaviour. Sixty-nine percent of the sample were Pakeha, 16% were Maori or part Maori. Fifty-seven percent of the sample were female, and 42% were male.

3.5.1 Age At the time of the survey, 70% of both males and females in the sample had smoked at least one cigarette. For those who had tried smoking, there was no statistically significant difference in smoking between the age groups. 20-30% did not smoke again after their first cigarette, 30-40% smoked occasionally, and 30- 40% smoked "Lots of times". Of the 13 year olds, 46% of the females and 38% of the male had tried smoking. For both sexes 80% of 15, 16, and 17 year olds had tried smoking. Both males and females were more likely to have tried smoking as theygot older, but the overall percentage smoking "lots of times" increased with age for females but not males.

The figures suggest that if the subject has not tried smoking by the age of 15, he/she is less likely to start, but unfortunately the age related data in the survey are compromised by the nature of the sample i.e. all school children. It is likely that on average the older students had a higher intelligence, socio-economic status etc. than both the younger children who had not reached the school leaving age, and .the general population of the same age.

3.5.2 Gender In our sample, slightly more females than males had tried smoking. Of those who had tried smoking, more males (60%) than females (45%) had stopped smoking by the time of the study. - There was no statistically significant difference between the sexes at the thirteen year old level, but as age increased, females showed a significant increase in smoking behaviour in comparison with males. Three times as many females continued to smoke after their first cigarette. In the 16-17 year age group, 39% of the females and 24% of the males had smoked "lots of times": (26%) of females vs. 11% of males became "regular smokers". Thus in our sample, smoking clearly increased with age among females, but such an increase was not so apparent for males.

162 3.5.3 Ethnicity

The total number of Maori in the sample was small relative to non-Maori. Over 80% of both male and female Maori had tried smoking compared to 70% of non- Maori. More Maori smoked regularly than non-Maori, but closer examination indicated that this difference was for females only. 65% of Maori females had tried smoking compared to 16% of non-Maori females. 55% of Maori females vs. 35% of Non-Maori females were current smokers. 40% of Maori females were "regular smokers" compared to only 15% of Non-Maori females.

Among Maori in our sample, four times as many females (40%) as males (10%) were "regular smokers". Among the Non-Maori, females again smoked significantly more than males, but the difference was relatively small. For males in our sample, there was no difference in smoking behaviour between Maori and Non-Maori.

3.5.4 Area

Of all the areas, Hawkes Bay had the highest percentage of subjects who had tried smoking at least once (77%), the highest percentage who had "Smoked lots of times (38%) and the highest percentage of "regular smokers" (24%). In comparison Wellington had only 8% of regular smokers - the lowest of any area. Subjects of both genders and both ethnic groups smoked more in the Hawkes Bay sample than in the other areas, although not all differences reached statistical significance. These differences may be attributable to the geographic location, but could just as easily be the result of differences in the socio-economic status of the schools catchment areas or even the result of non-homogeneous selection procedures for students between one school and another.

3.5.5 Source of cigarettes The majority of subjects in our sample either purchased their cigarettes themselves or obtained them from friends. As expected, the number of subjects purchasing their cigarettes from a shop increased from 32% for the 12-13 age group to 57% for the 16-17 age group. There appears to be an increasing use of slot machines from 3% use in 1989 (NRB, 1989) to 9% use in 1993. Children in the younger age group were less likely to obtain cigarettes from their parents.

3.5.6 Brand awareness

Winfield (cited by 59% of the sample), Pall Mall (60%), Benson & Hedges(47%), Rothmans (43%), Holiday (32%), Peter Jackson (31%), John Brandon (23%), Camel (13%), Marlboro (11%), and Dunhill (11%) were mentioned more frequently than other brands.

163 Winfield and Rothmans were mentioned more often by Maori subjects: Benson & Hedges and Marlboro more often by non-Maori subjects.

3.5.7 Brand preference Pall Mall (cited by 27% of smokers in the sample), Winfield (26%), Benson & Hedges (15%), Rothmans (13%), Holiday (10%), John Brandon (9%), Peter Jackson(7%), Dunhill (4%) were the brands most "usually smoked" by our sample. 10% preferred tobacco. More females than males preferred Pall Mall. More males than females preferred Marlboro. Benson & Hedges was identified as the preferred brand by nine times as many Non-Maori as Maori. Less subjects in the Wellington sample identified Winfield as their preferred brand in comparison with the other areas. Conversely more Wellington subjects preferred Pall Mall than in other areas.

3.5.8 Reason for the brand preference Taste was identified as the main reason for brand preference by 55% of smokers in the sample followed by price (21%). 44% had no brand preference. Association of the preferred brand with either a sporting or non-sporting event was cited as the reason for brand preference by only 3-5% of the sample. Subjects recording no brand preference declined from 65% in the 12-13 age group to 37% in the 16-17 age group. Older subjects were more likely to cite taste as the reason for brand preference. Females were more likely than males to cite price as a reason for brand preference.

There were no differences in reason for brand preference between ethnic groups. There were no marked differences in reason for brand preference between the samples in different areas.

3.5.9 Brand association In our sample only three brands of cigarettes were significantly associated with sporting events. These were Winfield (cited by 50% of the sample), associated with rugby league, soccer and softball, Benson & Hedges (28%) associated with Tennis, and Rothmans (26%), associated with car rallying, motor cycle racing and car racing.

Twenty-four percent of the sample knew that Benson & Hedges sponsored fashion awards.

Activities believed to be Smoke-free sponsored were Netball (cited by 31% of the sample), Basketball (19%), and Rockquest (4%). There were highly significant correlations between Brand Awareness, Brand Preference and Brand Association with Sport.

164 Chapter 4 Survey of retailer information and

support needs regarding the Smoke-free Environments Act (1990)

4.1 Introduction This section of the report deals details retailers responses to Part II of the Smoke- free Environments Act (1990). Part II of the Act seeks to legislate restrictions on the marketing, advertising, and promotion of tobacco products through sponsorship. One of the aims of Part II is to regulate tobacco advertising in all shops and in the media.

There is some concern about non-compliance with the advertising code and the sale of cigarettes to persons under 16 years of age by retailers (ASH, 1992, 1993 - Smoke- free Times).

Since 16 December 1990 new signs advertising tobacco products must not be put up in or outside shops. Retailers may: display tobacco products in their shop but they must not be able to be seen from outside your shop display notices inside their shop identifying the tobacco products they have for sale and their prices. These notices must not be bigger than 297 mm x 630 mm.

display the name of their business on the exterior of their shop, even though the name indicates that they sell tobacco products e.g; "Seymours. Tobacconist". The name cannot include the trademark or company name of a tobacco product. The name cannot be displayed on the exterior of their shop more than twice without displaying a health message. Retailers who do not comply with the requirements set out above are breaking the law and if convicted may be fined up to $10,000. It is also illegal for retailers to sell cigarettes or other tobacco products to persons under 16 years of age. All retailers should clearly display a notice to that effect for the public to see. If convicted, retailers can be fined up to $2,000 for shelling such products to persons under the age of 16.

The Department of Health, through the Director General, or some other person authorised. for that purpose by the Director-General, has been given the responsibility of monitoring compliance with the requirements of the Smoke-free Environments Act 1990 (Part II), see section 37 (2). The Smoke-free Environments Amendment Bill (No. 2) was introduced by Simon Upton on 4 June 1991. This includes provision within the enforcement section for the Director Generals authority to be delegated to area health boards.

165 II

To date only one formal complaint, leading to the presentation of the case in court, has been laid (via the Director General of Health) by the Canterbury Area 11 Health Board. A successful prosecution resulted from this first test case. AS part of its responsibility to monitor compliance with Part Environments Act 1990, the Department of Health has: II of the Smoke-free II

As part of the promotion for World Smoke-free day (31 May 1992), a letter was distributed to 13,500 retailers reminding them of their obligations II under the Smoke-free Environments Act 1990. • A publicity pack, containing press releases and the letter sent to retailers, ii was posted to 107 community newspapers in 1992. • A number of radio interviews and an item on the Holmes television show A informed the public about the requirements of the Smoke-free Environments Act 1990.

• A group of fifth year medical students undertook a survey of representative I sample of Wellington dairies to monitor compliance with the requirements of Part II of the Smoke-free Environments Act 1990, (Rose, et. al., 1992). 11 Given the concern mentioned above, the Department of Health determined there was a need to detail the extent of understanding and knowledge of retailers regarding the sale of cigarettes and tobacco products. II 4.2 Aim A The aim of the retailer was:

To determine what additional information and support retailers may need to I be fully conversant with the Smoke-free Environment Act 1990. It was not the purpose of the retailer survey to monitor compliance with the Smoke-free Environments Act 1990 (Part II) by retailers, but to generate an II information base from which gaps in current knowledge and understanding of the requirements of Part II of the Smoke-free Environments Act 1990 could be established and determine where future resources could best be allocated. II 4.3 Methods II The yellow pages of Telecom telephone directories were used to obtain the population of retailers sampled. The headings scanned were "dairies" and "Grocers and Supermarkets". The 18 telephone books were: II Northland Auckland Waikato, King Country and Thames Valley Hawkes Bay Taranaki Gisborne Manawatu Wairarapa Bay of Plenty Wellington Wanganui Christchurch Nelson II West Coast and Buller Blenheim Dunedin Timaru and Oamaru Invercargill II II

166 II The completed questionnaires were entered into a Paradox database and PC SAS was used to conduct the statistical analysis of the data set.

43.1 Response Rate

Scanning the yellow pages listings for dairies and grocers/supermarkets/etc from eighteen telephone books yielded 1403 dairies and 1246 grocers/supermarkets/etc. This gave a total sample of 2649. Therefore, 2649 surveys were posted out during February and March 1993. Of these, 45 were returned as either gone no address, not completed, after the deadline for receipt of the surveys or in one case, it was returned from a street post-office box which had been set alight. The final sample size used in the analysis was 1017, which represented a response rate of 39 percent. That is, approximately four in ten daiiy, grocery, supermarket, etc. retailers listed in the yellow pages of the telephone books completed and returned the survey. This is lower than expected, but there was no follow-up of non-respondents as it was an anonymous survey and the researchers had no way of knowing what retailers had returned the survey. It is also possible that some retailers thought the results would be used for monitoring compliance of the smoke-free legislation and were therefore reluctant to complete the survey.

167 4.4 Results

4.4.1 Description of the sample

As the survey was anonymous little information was collected from the retailers regarding the nature of the respondents or the retail business. Table 4.1 below details the number of dairy retailers and gr returned the survey. oceiy/supermarket/etc retailers that

Table 4.1 Type of retail business

N %(N)

Dairy 552 54.3 Grocer/Supermarket/etc. 465 45.7

N 1017

Just over half the retailers represented dairies and just under half were retailers from grocery, supermarket or related businesses.

The retailers were also asked how long they had in business at the current address. This result is presented in table 4.2 below.

168

-.-- Table 4.2 Length of time retailer at current address

N %(N)

Less than 1 Year 169 17.2 1 -2 Years 197 20.1 2-SYears 296 30.1 More than 5 Years 320 32.6

N 982

Approximately one third of the sample have been a retailer at their current address for more than five years. Three out of ten retailers have been at their present address between two and five years, with the remaining 37.3 percent reporting being at their present address for two years or less. This indicates a wide spread of experience in our sample, although it is possible that the retailers reporting two or less years at the current address may have been a retailer at another previous address. So length of time at the current address is used as indicative measure of retail experience rather than as an absolute measure. Both type of business and length at the current address were used as variables in cross-tabulations to ascertain if there were any significant differences between these variables and the respondents information and support needs.

4.4.2. Retailer Smoke-free legislation information sources and content Retailers were asked if they had received any information regarding the Smoke- free legislation. The results are presented in Table 4.3 below. Just over 60 percent of the respondents indicated that could recall receiving information regarding the requirements related to the Smoke-free legislation. However, a significant number, one third of the respondents, indicated they had not received any information. Information regarding the Smoke-free legislation could have covered aspects of Part I, smoke-free workplaces (see Brander, 1992) or Part II, restrictions on the marketing, advertising, and promotion of tobacco products through sponsorship.

169 Table 4.3 Have you received any information about the Smoke-free legislation?

N % (N) % (Sample)

Yes 608 61.4 59.8 No 328 33.1 32.3 Dont Know 59 5.8

N 991

To further ascertain if any differences existed in the recall of receiving information about the Smoke-free legislation between the retailers, cross-tabulations were performed with respect to: type of business (dairy vs g rocery/supermarket) and length at current business ( < 1 year, 1-2 years, 2-5 years, and > 5 years). The cross-tabulation tables resulting in statistically significant differences are presented in appendix 4.

Two thirdsof grocery/supermarket retailers indicated they had received information in comparison with 57.7 percent of dairy retailers. Also, more dairy retailers indicated they had not received information in comparison with grocery/supermarket retailers. Thus, efforts to disseminate information on the Smoke-free legislation should focus on dairy retailers.

There was a statistically significant retailer response to receiving information about the Smoke-free legislation as a function of the length of time at the present business. This is illustrated in figure 4.1 below. Retailers who had been atthe current address less than one year were more likely to respond that they hadnt received any information (68.9 percent) in comparison with retailers who had been at the present address for over 5 years (13.8 percent). Only one quarter of the "less than one year" retailers indicated they had received information on the smoke-free legislation.

Clearly, "new" retailers and those "new dairy" retailers should be targeted to receive information regarding the obligations of retailers under the requirements of the Smoke-free legislation.

170 Figure 4.1 Information received about the Smoke-free legislation

percent respondents

length of time at current business

^ M D/K No Yes

171 U Retailers who had received some information about the Smoke-free legislation were further asked to indicate the source of this information. The results are presented in table 4.4 below. n

Table 4.4 Source of the Smoke-free legislation information. U ci N % (N) 1 (sample) U

Dept. of Health 388 63.3 Area Health Board 38.2 110 17.9 10.8 El Tobacco Companies 222 36.2 21.8 Family, friends 26 4.2 Mixed B. Association 2.6 47 7.7 4.6 Tobacco Institute 23 3.8 U Retailers Assoc. 2.3 167 27.2 16.4 Newspaper etc. 113 Other 18.4 11.1 49 8.0 4.8 El

N 613 U

1 The percent values will not add up to 100 percent because multiple options were El possible and respondents could have selected more than one response. Over sixty percent of the respondents cited the Department of Health as the U leading source of information about the Smoke-free legislation. In May 1992, the Department of Health distributed 13,500 letters to retailers informing them of the requirements of the legislation. The next highest information source was tobacco El companies, with just over a third of respondents indicating they had received information from this source. The other main information sources were: the Retailers Association (27.2 percent), Newspapers, etc. (18.4 percent) and area health boards (17.9 percent). The finding for area health boards was lower than ci might have been expected given the establishment of Smoke-free co-ordinators in all area health boards and the activities they have implemented (see Tyndall, 1992). It ispossible that the role of Smoke-free Co-ordinators could be expanded U to include liaison with retailers, especially new retailers. For example, when a retailer sets up a business they have to register it with the local council office. This would be an effective time to visit the new retailer and inform them of the IJ requirements of the Smoke-free legislation. I pointed up this point in a interview with a area health board Smoke-free Co-ordinator as follows: ci DOH I understand that when a new person takes over a dairy they have to register the dairy with the city counciL U AHB Thats right. ci U 172 U DOH If the Smoke-Free Team could get the new registrationsfor the month say from the city council that would be afoot in the door for youto visit this dairy owner with your pamphlet about the legislation and say I understand that you are new to the dairy, Im from the area health board, Im here to help you in any way I can. One of my functions is to inform you of all the legislation, theyll immediately think offood hygiene and everything else and then you can say thats right, and part of it is also the Smoke-Free Legislation - here is a pwnphlet detailing your requirements. I see that you dont have an under age sign, would you like this sign to put up. And maybe thats a way of keeping on top of it. Now I dont know ifyouve got the resources to do that? AHB Urn...

DOH But thats one way of seeing the new retailer

But suppose, in a sense, its coming back to what... said about what strategy works best, whether a prosecution versus a pamphlet, was best. Its trying to bring it into the operational plan, trying to develop the strategy whereby you are maximising your efforts by visiting a new dairy owner at the very beginning and providing them with the information and hopefully you wont have any more need to visit them again through a complaint or whatever else because theyre complying with the legislation. And also its providing them with information and education.

There was a significant difference between the retailers on recall of the number of information sources they had received smoke-free legislation information from. This is illustrated in figure 4.2 below.

Nearly all retailers (89.4 percent) who have been at the present address for less than one year cited receiving information from one source only, while only 56.9 percent of retailers at the present address for longer than five years cited one information source. Only four percent of "new" retailers cited information had come from three or more sources in comparison with 20.6 percent of retailers who have been at the current business for greater than five years. This result maybe due to the exposure effect, the longer you are in business the more likely you are going to be exposed to information from a variety of sources.

173 Figure 4.2 Number of cited information sources

percent. respondents

/ J 20

< 1 yr 1-2 yrs 2-5 yrs 5+ yrs 1 source 89.4 81.2 66.9 56.9 2 sources 6.5 12.2 16.5 22.5 3+ sources 4.1 6.6 16.6 20.6 length of time at current business

3+ sources ____ 2 sources I 1 source

174

A number of "other" organisations were mentioned by retailers as Smoke-free legislation information sources. These included: MP Newspapers and radio. PUFF Gisborne City CounciL Companys Head Office. Government Dept. TV Retail group. Employers Federation. Some from my son involvement in Smoke-free. National Maori Women Welfare Naigon League. Retailers Assn Internal company mail. District Council Health Inspector. Newspaper account only. Foodstuffs Ltd. Head office.

Those retailers who had received information regarding the Smoke-free legislation were also asked what was the content of this information. The results are presented in table 4.5 below.

Table 4.5 Content of the Smoke-free legislation information.

N %(N) % (sample)

Smoke-free workplace policy 406 Sale of cigarettes to under 16 year olds 64.6 39.9 92.0578 56.8 Health message on tobacco advertising signs 357 Display of tobacco products in shops 56.8 35.1 326 51.9 32.1 Display notices about tobacco products 276 Display notices about tobacco company 43.9 27.1 sponsored sports events 106 Information about the use of vending 16.9 18.4 machines 22 Use of tobacco products as gifts 3.5 2.2 Other 60 9.6 5.9 3.019 1.9

N (respondents) 628

175 Nearly all (92 percent) of the retailers who received information recalled it involved information about the sale of cigarettes to under 16 year olds. While this is a high percentage of respondents it represents just over half (56.8 percent) of all the retailers in the sample. Nearly two-thirds of respondents (64.6 percent) recalled receiving information about Smoke-free workplace policies. The next most frequently recalled types of information were: health messages on tobacco advertising signs (56.8 percent) and the display of tobacco products in shops percent). (51.9

The number of different types of information content received by length of time at their current address is presented in figure 4.3 below. Nearly all the "new" retailer respondents (88.2 percent) reported receiving 1 or 2 types of information regarding the Smoke-free legislation in comparison with half (47.8 percent) those retailers at the current business for five or more years. The longer the retailer was at the current business the more likely they were to report receiving five or more types of information. Again, this represents an "exposure effect", but also highlights that "new" retailers, as a matter of course, are not exposed to much material relating to the Smoke-free legislation and therefore a mechanism should be developed to inform retailers of their requirements as early as possible. One possible mechanism, that is, obtaining business registrations form the local council on a regular basis, was discussed above.

4.4.3. Retailer understanding of the Smoke-free legislation

Retailers were asked if they understood the requirements of the Smoke-free legislation regarding the advertising and sale of cigarette and tobacco products. The results are presented in table 4.6 below.

Table 4.6 Retailer understanding of the requirements of the Smoke-free legislation.

N % (N) % (sample)

Yes 482 48.3 47.4

Some of it 472 47.3 46.4 Dont Know 51 5.1 5.0

N 997

176 Figure 4.3 Number of smoke-free information issues

percent respondents

100 - /I 80 - J

< 1 yr 1-2 yrs I 2-5 yrs 5+ yrs 1-2 issues 88.2 70.6 56.1 47.8 3-4 issues 4.7 18.8 19.9 25.2 5+ issues 7.1 10.7 24 25 length of time at current business

5+ issues ____ 3-4 issues ____ 1-2 issues

177 Approximately half the retailers considered they understood the requirements of the Smoke-free legislation and half thought they understood some of the requirements. Again, there is a clear need to update retailers of their requirements. Retailer understanding of the Smoke-free legislation illustrated by length of time at the current business address is presented in figure 4.4 below. Whereas just over one third of "new" retailers considered they understood the legislation, just over half (54.7 percent) of retailers who had been at the current business for more than five years reported they understood the requirements of the legislation. The more experienced the retailer the more likely they were to report an understanding of the requirements of the Smoke-free legislation. This result indicates that newly established retailers should be targeted to receive information on the retailer requirements related to the Smoke-free legislation. The retail industry has a high number of part-time and casual staff. It was therefore felt important to ascertain if retailers considered that their staff understood the requirements of the Smoke-free legislation. The retailers views regarding their staff is presented in table 4.7 below.

Table 4.7 Retailer perception of their staffs understanding of the requirements of the Smoke-free legislation.

N % (N) % (sample)

Yes 564 57.6 55.5 No 278 28.4 27.3 Dont Know 130 13.3 12.8. Sometimes 16 1.6 1.6

N 979

Just over half (57.6 percent) of the respondents reported that thought their staff understood the requirements of the Smoke-free legislation and just over a quarter felt their didnt understand the requirements associated with the leislation. So not only do retailers or the owners of the retail businesses need to be informed of the legislation and its implications for them, but part-time and casual retail staff should also receive information about the Smoke-free legislation.

178 Figure 4.4 Retailer understanding of the Smoke -free legislation

percent respondents

length of time at current business

D/K some of it Yes

179

When the retailers were categorised into dairy or grocery/supermarket retailers, it was found that dairy retailers (60.2 percent) were more likely to consider their other staff understood the legislation in comparison with grocery/supermarket retailers (55.9 percent). Whereas one in four dairy retailers felt their staff didnt understand the requirements of the legislation, this was one in three for grocery/supermarket retailers. Again, grocery and supermarkets would employ more part-time and casual staff in comparison with dairies and therefore the need to provide grocery/supermarket staff with information about the smoke-free legislation would be greater.

4.4.4. Retailer Smoke-free legislation information needs

Retailers were asked if they wanted more information on the requirements of the Smoke-free legislation from the Department of Health. Their replies are presented in table 4.8 below.

Table 4.8 Do you [the retailer] want more information on the requirements of the Smoke-free legislation from the Department of Health?

N % (N) j % (sample)

Yes 587 59.4 57.7 No 364 36.8 35.8 Dont Know 40 4.0 3.9

N 988

Nearly sixty percent of the respondents indicated they would like further information about the Smoke-free legislation from the Department of Health. When this was broken down by length of time at the current business address (see figure 4.5), three out of four "new" retailers wanted further information in comparison with one in two of those retailers with more than five years at the present business address. While only 19.8 percent of the "new" retailers said they didnt want further information, half of the "established" retailers said they didnt want further information about the Smoke-free legislation.

The respondents who wanted further information were asked in what form they would like this information. The results are presented in table 4.9 below.

180 1

Figure 4.5 Do you [retailer] want more information on the requirements of the

Smoke-free legislation from the Department of Health?

percent. respondents

80 60 / ... n 40 20 / / / O- I / / < 1 yr 1-2 yrs 2-5 yrs 5+ yrs Yes 75.4 62 58.5 50 No 19.8 33.7 36.9 47.1 D/1< 4.8 . 4.3 4.5 2.9 length of time at current business

D/K No LIIlYes

181 Table 4.9 If you [the retailer] want more information on the requirements of the Smoke-free legislation from the Department of Health, what type of information would you prefer?

% (N) % (sample)

Written material, etc 551 92.1 54.2

Free-phone help 76 12.7 7.5

Personal visit 77 12.9 7.6

Other 31 5.2 3.0

N 598

Nearly all the respondents (92.1 percent) indicated they wanted further information in written form. Only 12.7 percent of the respondents wanted a national free-phone or help line and 12.9 percent of respondents indicated they would like a personal visit. Clearly, the distribution of written material to retailers on the requirements of the Smoke-free legislation would be well received, especially by "new" retailers.

The respondents made a number of comments about the type of material they would like to receive. The comments included the following statements:

Sign and stickers should be freely Written material with examples of legal available. Ido mind just a bit having to and illegal sales e.g. child with a note pay for them now; however will do it as from a sick parent; a 16yr buying cigs we support it. on behalf of a 15 yr friend in the shop Bold type in store posters showing etc. cigarettes not for sale to under 16 yr How to prevent people walking around olds. with a lit up cigarette in their hands. Written material hopefully will be in Would like table notices. laymans terms so we can fully Signs stating no smoking please. understand it. Would like brochure and basic info for All our legal obligations required by the our staffroom; would like someone to act. explain to staff sometime as there are a Need new signs for Ulóyr old lot smoking, mainly young people. restriction. Signs, display etc. We have 3 legal definitions for shop Afee copy of the Act. display of tobacco products - want If new instructions come out the clearer definition ie where to place etc. retailer should be advised of them. Effective date for legislation re visibility Anything pertaining to law. ofproduct from street, and when penalties will be enforced.

182

Smoke free signs for areas. We have A visit from an official capacity to been to our local council for these signs check our rotary cigarette stand to see if but have had no luck We have a it complies with regulations. tearooms on our premises that is smoke A video tape on guide-lines (dos and free. donts). This may be hired. Any updated information.

4.4.5. Support and assistance provided to retailers regarding the Smoke-free legislation

Retailers were asked if they had received any support and assistance from a variety of organisations promoting the Smoke-free legislation. The results for the organisations are presented below.

Table 4.10 below summarises the retailers views regarding the assistance and support received from the Department of Health.

Table 4.10 Retailer recall of support/assistance received from the following organisations

Yes No Dont Know N % N % N Dept. Of Health 273 33 484 59 64 7 Area Health Board 101 14 537 75 77 11 Retailers Assoc. 176 24 503 69 55 7 Mixed Business Assoc. 53 8 549 83 58 9 Tobacco Institute 35 6 540 84 67 10

Tobacco Companies 254 34 437 58 60 8

Other organisations 20 5 353 82 58 13

Only a third of retailers indicated they had received support or assistance from the Department of Health and tobacco companies, respectively, in association with the Smoke-free legislation. Again, when assessed by years at the current address (see figures 4.6 and 4.7) the "new" retailers were less likely to have received support and assistance from the Department of Health and/or Tobacco Companies in comparison with the "established" retailers. Also, the "new" retailers were more likely to recall not receiving support and assistance from the Department of Health and/or Tobacco Companies in comparison with "established" retailers.

183 Figure 4.6 Retailer support and assistance from the Department of Health

percent respondents 100-/I =______I L I < .1 yr 1-2 yrs —5 yrs 5+ yrs D/K 7.8 9 10.1 5.3 No 77.8 64.5 55.7 46.3 Yes 14.4 26.5 34.2 48.4 length of time at current business

D/K ___ No [T1 Yes

184 — — — — — — — — — — — — — — — — — — — —

1 Figure 4.7 Retailer support and assistance from Tobacco Companies

percent respondents 100

- A 60 40 20 0 < 1 yr 1-2 yrs 53.2yrs 5+ yrs 9.1D/K 8.3 8.5 7 No 78.2 61.5 53.2 47 Yes 12.7 30.1 38.3 46 length of time at current business

D/K No [ 1 Yes

185 The next most frequently reported organisation providing support and assistance was the Retailers Association, with 24 percent of the respondents indicating they had received support and assistance from this organisation. The "established" were more likely (47.9 percent) to report receiving support and assistance from the Retailers Association compared to the "new" retailers (4.9 percent), see figure 4.8. Also, while only 10 percent of dairy retailers indicated they had received support and assistance from the Retailers Association, 40 percent of grocery, supermarket retailers reported receiving such support and assistance. It would therefore appear that either more grocery and supermarket retailers belong or have associations with the Retailers Association or the Retailers Association targets its programme more towards grocery and supermarket retailers in comparison with dairy retailers. Whatever the reason, the Department of Health should be targeting dairy retailers, who appear less likely to receive support and assistance from organisations in comparison with grocery and supermarket retailers. Only 14 percent of retailers indicated they had received support and assistance from area health boards. This is lower than might have been expected given the network of area health board smoke-free co-ordinators that have been established (Tyndall, 1992). Again, "new" retailers (3.6 percent) were less likely to report receivingit support and assistance from area health board staff in comparison with retailers (28.5 percent), see figure 4.9. Nearly 90 percent of retailers who have been at the current business address for one year or less reported they had not received support and assistance from area health board staff. This reinforces the proposition above that when retailers establish a business or move into an existing business, this would be an appropriate time for information about the requirements of the Smoke-free legislation to be disseminated to these retailers. It would appear from the results above that little or no interaction between "new" retailers and organisations promoting the Smoke-free legislation is taking place.

Very few retailers reported receiving support and assistance from the Mixed Business Association (8 percent), the Tobacco Institute (6 percent) or other organisations (5 percent). The Department of Health and Tobacco Companies appear to be the organisations disseminating most of the information and providing most of the support and assistance to retailers about the requirements of the Smoke-free legislation.

The "other" organisations noted by the retailers that had provided them with support included:

Wills NZ Discussed with Tobacco representative Nwon Government Employers Assn Foodstuffs PUFF Our company Head office Employers Assn

186

Figure 4.8 Retailer support and assistance from the Retailers Association

percent respondents 100

60 U Ii 40

20 •_ 0 < 1 yr 1-2 yrs 2-5 yrs 5+ yrs

D/K 8.4 9.5 7.6 5.6

No 86.7 81.1 69.8 46.5

Yes 4.9 I 9.5 22.6 47.9 length of time at current business

D/K ___ No L 1 Yes

187

Ii Figure 4.9 Retailer support and assistance from area health board staff

percent respondents 100

80 60 40 20 0

< 1 yr I 1-2 yrs 2-5 yrs 5+ yrs D/K 9.2 10.6 13.3 8.8 No 87.2 80.8 74.3 62.7 Yes 3.6 8.6 12.4 28.5 length of time at current business

D/K No LYe

188 — — — — — — — — — — — — — — — — — — — — 4.4.6. Sale of cigarettes to individuals under 16 years of age

Retailers were asked if they had received from the Department of Health or any other organisation a sticker indicating that they cannot sell cigarettes to tobacco to persons under 16 years of age. The results are presented in table 4.11 below.

Table 4.11 Have you [retailer] received sticker indicating you cant sell cigarettes or tobacco to persons under 16 years of age?

N % (N) % (sample)

Yes 878 86.9 86.3 No 113 11.2 11.1 Dont Know 19 1.9 1.9

N 1010

Overall, a high number of the respondents reported that they ha j received the sticker indicating they could not sell cigarettes or tobacco to under 16s. While two thirds of "new" retailers indicated they had received a sticker nearly all of the "established" retailers (96.5 figure 4.10. percent) indicated they had received a sticker, see

Retailers were asked, later on in the survey, if they agreed or disagreed with the following statement "a retailer cannot sell cigarettes or tobacco products to persons under the age of 16 years". Eighty eight percent of respondents agreed that this was a requirement of the Smoke-free legislation, with only 10 percent of the respondents disagreeing. While 85 percent of dairy retailers agreed with this statement, nearly all grocery and supermarket retailers (92 percent) agreed with the statement that they could not sell tobacco products to persons under 16 years of age.

Nearly all retailers, 91 percent, agreed with the statement that they should display a sign in their shop that the sale of tobacco products to persons under 16 is prohibited.

Just over three quarters of respondents (77 percent) were aware that retailers who sell tobacco products to people under 16 years of age can be fined up to $2,000, if convicted. However, a significant number, 20 percent, indicated that they were not aware of this aspect of the Smoke-free legislation. Sixty percent of "new" retailers were aware of the fine, if convicted, for selling cigarettes to minors, in comparison with 83 percent of "established" retailers. A third of "new" retailers indicated they

189 were not aware of this aspect of the Smoke-free legislation in comparison with only 15 percent of "established" retailers.

While many retailers have received the sticker outlining their legal requirement not to sell cigarettes to under 16 year olds, and know that it should be displayed, it is clear from chapter 3 that this alone is not an effective prevention strategy. Also, even though the stickers have been received by the majority of retailers in our sample, it was beyond the scope of this study to measure compliance with the "display clearly for the public a notice to the effect that the sale of any tobacco product to persons who have not attained the age of 16 is prohibited" (section 30, clause 5, Smoke-free Environments Act, 1990). A study of a representative sample of 88 Wellington dairies by fifth year medical students looked at this aspect of the requirements of the Smoke-free legislation. Rose et. al. (1992) reported that 59 out of 88 dairies (67 percent) displayed a sticker indicating the restriction of the sale of tobacco products to under 16 year olds. Of the shops that displayed the sticker, 54 (92 percent) displayed it in a clear and visible manner. Therefore just over one third of the diaries (37 percent) either didnt display a sticker or displayed in such a manner that it could not be easily seen. The mostprominent locations where the stickers were located included: the shop front door (39 percent), shop counter (31 percent), cash till (22 percent) and the front window (41 percent). Also, Rose et. al. (1992) reported geographical variation in the presence or absence of display of the under 16s sticker. Approximately 40 percent of diaries located in the southern suburbs of Wellington clearly displayed the sticker in comparison with approximately 80 percent of dairies in the Western suburbs, Porirua district and Lower Hutt. Only half of the central city shops clearly displayed a sticker. With respect to the sale of cigarettes to under 16s, Rose et. al. (1992) concluded:

We believe that there are grounds for a test case to be brought to trial against dairies that: 1) do not display the U16 sign; 2) use advertisements without any health warning. This would set a precedent for further enforcement.

Standardised specifications for the U16 sign should be outlined. These should include positioning and size of the sticker.

There is a need for a study into tobacco sales to under 16 year olds. Retailers were asked if it was difficult for them to tell if a customer was under 16 years of age. The results are presented in table 4.12 below.

190 Figure 4.10 Have you [retailer] received a sticker stating that you can It sell

cigarettes or tobacco to under 16s?

percent respondents

100 80 60 40 20 0

< lyr 1-2 yrs 2-5 yrs 5+ yrs

Yes 67.3 81.6 91.2 96.5

No 28 16.3 7.4 2.5

D/K 4.7 2.1 1.4 1 length of time at current business

191 Table 4.12 Is it difficult for the retailer to tell if a customer is under 16 years of age?

N % (N) % (sample)

Yes 761 75.5 74.8 No 216 21.4 21.2 Dont Know 10 1.0 1.0 Sometimes 31 3.1 3.0

N 1008

Three quarters of the retailers indicated is was difficult for them to tell if the customer was under 16 years of age. Approximately 21 percent of retailers reported they had no difficulty determining if a customer was under 16 years of age. For the majority of retailers there is uncertainty regarding the age of customers, especially determining if they are under 16 years of age. As a follow-on question, retailers were asked what would make it easier for them to determine the age of customers, especially those under 16 years of age. Their comments fell into a number of categories and these are summarised below.

The use of ID cards was mentioned by a number of retailers. The grocery/supermarket retailers comments included:

Every person should carry personal ID so there is no question whether or not All 16-19 yr olds wishing to purchase she is under age, raising the age may be cigarettes or tobacco should have some another good option. form of identification stating their age, Form of ID. otherwise shopkeepers should refuse to I dont think its up to the retailer to sell cigarettes/tobacco to them. identify the age of the person and Apart from student ID cards its almost certainly shouldnt get penalized if impossible to tell an under 16 to a 16yr making a mistake. old. I dont think that changing the age Does not matter as Q. of age has to be from 16 to 18 would make any asked to the customer whether they are difference. An ID with photo is the only 16 or 18. There is NO WAY of positive way to be reasonably sure. ID or age. To be sure every person" I still think that persons should cany should cariy a "pictured" ID card ID card with photo. Every person having some ID on them I would like to see legislation. regarding to prove their age. parents who send their kids to shops to buy smokes; they know the law. We get

192 abuse from some parents because we Only difficult for the 13-16 yr age wont sell cigs to their kids. bracket - this will be a problem ID and educate children under 16yrs. irrespective of the age restriction unless Fine under 16 yr olds caught smoking ID is compulsory for the school not retailer. kids/teenagers. ID card with birthdate & photo on it. It Only positive ID with photo will solve is very difficult to judge age of children this problem. between 14 & 18yrs of age. Perhaps some form of ID for ages 16 & ID cards but the civil liberties people over - if under then no ID - no smokes. think we shouldnt have to carry one - Personal ID. what have they got to hide? Provide identification on request. ID with a photograph of each person. There are no easy answers to this Failing this do not have any age question. We all know heaps of under restriction. We ask if they are 16, if age people have been drinking in hotels they say yes we have to sell them to for years. (ID card) them. They should have ID with photograph If I am doubtful I ask for ID to verify and proof of age. We take too much age and I am of the opinion that the abuse when questioning the age of reaction I get is an indication if the teenagers. person is under age. If I have any Unsure how to determine age short of doubt I will not sell. ID. If in doubt we ask if they say they are Using some type of identification with 16 we selL I dont think we need to see the persons age and photo like ID or such. university ID and polytechnic ID. If student cards were brought in it would make identification easier.

Dairy retailers comments about the use of ID are summarised as follows:

is non-enforceable. Its impossible to Some form of identification always judge a persons age. If a person Birth certificate. some I have asked claims to be 16 then one has to accept have said they are 20 or 21. I their word. If they are 16 and you embarrassed them. refuse to sell then etc.. Youth card identification with their We should be able to or have the right photo on it would help, along with to ask for proper identification. birth date. We should be allowed to ask for Some sort of identification card! identification and if Provide an identification card for the not produced or age. provided then we Should be able to refuse, even though customer may be If in doubt, we ask for identification over 16. Identification card and photo showing year of Identification stating date of birth with birth etc photograph. Same problem would exist The only positive way is a photograph by getting rid of the age restriction style ID showing birth date, to be made altogether. Its a stupid law. available on request by the individual The only way this law can be policed is All children who are over 16 must carry if everyone carries an ID card with ID cards and produce on demand. birthdate - heaven forbid that day! More so it should be advertised to a) Its hard to tell a persons age. We avoid unwanted confrontations. The can only do our best. b) An amount of abuse & insult we get when identification card similar to a passport seeking ID is increasing rapidly. with photo & age would save retailers Until theres a law stating 16 year old from embarrassment of trying to guess must carry ID then I consider this law Customers age.

193 Change the legislation so that the meat in the sandwich in this case as we emphasis & onus of proof of age is are now. where it should be with the individual It would help with some form of customer & that they cop the identification as some 16 year olds do fine/prosecution. Retailers shouldnt be not look 16 refusal causes friction..

Those number retailers who thought that it was difficult to tell if a person was under 16 years of age, also commented that increasing the age to 18 years would not help overcome the problem. The grocery/supermarket retailers comments along these lines were as follows:

No - but our policy is that if there is Children nowadays are so much more doubt then we do not sell to that person sophisticated. My son is 12, he is 58" PS this No - it would be difficult to tell tall and would pass for 16 anywhere. whatever the age. Age limits make no difference. You will No - very difficult when trying to guess always have someone who looks older a young females age. We request ID in or younger than the age restriction. No any doubtful case. If in doubt - no sale! doubt all publicans would agree with this. No - we would be still stuck with the same problem. Style of dress today can Changing the age restriction would be hide age easily. People who are over the no help in my opinion. What about a age get quite irritable when questioned. birth cert. for all young people 16-20 No because girls in particular are hard say? If these young people can not to put an age on. produce the certificate - no cigarettes. No because you still need to check that I dont know if it will be easier to an 18 year old is 18 years old. A written recognise the age but I would like to see form similar to people buying wine the age limit changed. stating their age, it then puts I dont know what would make it responsibility on to the customer. easier it is almost impossible to tell No good raising to 18. Educate kids ages especially of young ladies if they through school not to smoke. have make-up etc on. No help at all especially for young girls. I dont think any age would make it No it is just as hard. However it would easier. We are not the police or mean the under 16s would be less likely government. to try. I would like to see legislation regarding No restriction at all - children purchase parents who send their kids to shops to for adults and we lose customers by buy smokes; they know the law. We get refusing service. abuse from some parents because we No there will always be difficulty in wont sell cigarettes to their kids. determining a persons age. It is not always easy to identify the age No unless people carry ID. Just of some individuals whether they are 16 because people turn 18 doesnt mean or 1& However am unable to think of a their age is tattooed on their forehead. better cost effective alternative. If you made the limit 40 we still It will make no difference, any age is couldnt tell! You may not believe this hard to pick but if we are unsure & there is no ID Making the age older would make no we do not supply the cigarettes. difference. It is very hard to pick No, even harder then. peoples ages these days. No, I dont think so both age groups Mostly it happens when a customer are difficult to tell their ages. does not look 16 but they insist they No, if people can enter the workforce at are. It is very difficult to ask for proof 15 they should be able to choose their as sometimes it may result in a violent own destiny. atmosphere.

194 No, in fact a person around 18 years of No. Should be prohibited to kids in age are harder to detect their age school uniform and after schools hours because some teenagers mature a lot they have to produce ID. later than others. No. These days it is very difficult to put No, it would be harder. The law an age on young people especially girls should fine the underage for breaking unless you know them, if you know the law rather than the retailer for they are at school we just do not sell to plying their goods. 16 year olds know them. the law. Nothing will make it "easier Raising No, just as difficult. the age would at least increase the No, leave it at 16; if a customer says availability of some form of ID. they are the correct age and we are not Nothing would make it easier as sure they are asked to sign a form teenagers nowadays look much older & stating this fact. also could lie about their age, perhaps No, that is equally as difficult. Children ID. need ID stating their age or parents Nothing. Raising the age to 18 years no consent to smoking. advantage; still sometimes difficulty to No, then you just have to determine if tell correct age. theyre 18. Raising the age would make no No, you start to defeat the age limit. difference asfar as I am concerned. Our local young persons are easy to Raising the age would not help. police. Arguments would be more volatile with No. All adolescent children can look older people. younger or older eg our area - jockey Raising the age would not solve the apprentices! problem. There will always be No. As I was asked to leave a hotel on difficulty in judging some peoples ages the day after I was 21 years of age by a especially those close to the restriction. person who had known me for 6 years. The law is silly - education is by far the No. Boys look and act younger; girls better option. Any age limit serves no are more mature. purpose. No. I just have to accept their word, There are no easy answers to this No. It only moves the problem up by 2 question. We all know heaps of under years. age people have been drinking in hotels No. Keep it at 16 More awareness is for years. (ID card) required. More emphasis & strict There is no easy answer. supervision at home & school needed. There is nothing that can be done to No use asking shopkeepers not to sell make this easier under age people can tobacco to underage. and will always make themselves look No. Lower the age to 14 as it is easier older than what they really are if they to tell age when they are younger. want something like this. No. Raising age does not help. We just insist on ID and phone parents. They normally then simply leave the store.

The dairy retailers comments about raising the age to 18 as being no solution to the problem of age identification and selling tobacco products to minors were as follows: Most young persons dont have ID Its extremely difficult to tell whether a notes can be forged. person is 14, 16 or 18. Age restriction No. Reducing the selection of tobacco has difficulties whichever age it is. products, ie: new products, delete an Apart from asking a persons age, we existing product. have no other way of determining age. No, I dont think anything will make it easier. Youll have 16 year. olds coming

195 in saying theyre 18. Without proof of hands the cigarettes to the junior. Then age, this makes it hard on the seller. they both laugh in my face & walk out. Age rise would make no difference. No - how can you tell if someone is 17 School pupils pose problems, but there or 18 either? Abolish these stupid will always be a few that "look young regulations - whatever happened to old adage: if in doubt-dont. free society? No, same problems as for 16. Apart It would probably be easier but the from the carrying of ID, I cant think of responsibility of selling to under-aged much that would make this easier- the people should be placed on them and abuse aspect of a refusal to sell is very not the retailer (if age limit is raised). tedious- especially with other customers No/ID card with photo, same as pub in store. card.. Absolute stupidity having age No, because it will still be a problem to restriction without the shopkeeper find out the ages of 16-18 year having some protection. olds./IDs would solve the problem. Age restriction will not ease the Raising the age would not solve the problem. I suggest - smokers to be problem. The retailer should never educated re: smoke-free legislation. ie: have been put in the position to ask for t. v. advert etc. age or proof of age. Age to 18-no!! The problem still exists Raising the age would be of little help. I as to how to identify a 16, 18 or 20 year make my own decision - if the old. As many dont have or carry ID customer doesnt satisfy me of their age cards/driving licence, etc, you have to no cigarettes from me. take a guess. Physical attributes (eg: do No. That is not the answer. There they shave, are they 5 or 6ft tall, how should be a similar form available to big is their etc...... moteliers association where person Prosecute under 16s and anyone else makes declaration that he is of a who supplies them with cigarettes or certain age. tobacco. It would be no different if the No, raising the age would make no age was 18. difference and when you refuse to sell No to raising the age - I refused to sell them they just get a friend who is 16 to to a 13 year old-he went to the next buy them, and you see them hand them dairy, got the cigarettes and came back to them outside the shop. So as far as I and laughed at me and said "ha ha you know it is not illegal to smoke under missed out on $10" and I cant afford 16, so the law is an ass. that. Dont really believe anything would No I dont think raising the age would make it easier. One has to make a help unless you raised the age of drivers judgement to say "no" on occasions. licensing, marriage, etc. The easiest way Sometimes one is wrong, but not often. is to refuse unless proved. No, its always hard to predict the age Raising the age only shifts the problem of a person and the doubt will always up a couple of years. Nothing short of be there. ID cards will help. Raising the age restriction will not Raising the age wouldnt make much make any difference. Personally difference as 16 year olds now look like speaking 16 years of age is not 18 year also, so I think it would just acceptable. Instead of not being able to make it harder. tell who is under 16, it will occur for 18 No, raising the age would not help. asking for identification is necessary, Making it compulsory for students to but having irritated customers etc.. show school ID cards would solve the No, it would make no difference; Ive problem. had a customer, obviously under the age This is a difficult area and some form of 16, asking for cigarettes, and of ID eg: birth certificates, drivers when Ive refused, their friend over the licence, etc. are the best method. A age of 16, buys them, & in front of me, further increase in age would not solve the problem.

196 No however by not selling cigarettes to person to buy for them. Underage all school persons in uniform would people get alcohol without any bother. help. Not really, you get abused left right and Raising the age from 16-18 would only centre from these rude individuals. be the same problem. Its just as hard No I dont think so because they will to tell al6 year old as an 18. To help give money to an older person to buy a our staff we also implemented a shop packet of cigarettes for them. rule, no cigarettes to children in school No, only use of ID cards or photos on uniform. driving licences. Raising the age from 16 to 18 would Same problem as bar staff have with not help. Kids will still get cigarettes, underage drinking. Not really they get older kids to buy for them. Kids enforceable - cigarette companies know have been buying smokes for years and that too!! I cannot see anything stopping them. No, as until everyone is required to No I dont believe raising the age would carry identification at all times (as in a make it easier for retailer at all. Where police or communist state). does it all end? Short of tattooing ages Identification on age is impossible. ps: on childrens forehead. ask the police how many under 18 year No, it would be difficult to estimate the olds drink in the hotels. age of a person at any cut off age. how No there is no difference - 17 looks like do you tell an 18 year old from a 19 18-15 looks like 16 and 19 can look year old -24 years from 25, 85 year old like 15 - get the picture!! If an age from 86 year old? policy is to be law - then in fairness to You cannot tell by appearance, ie: retailers & students then pictured ID some 14 years look like 16-17 and vice cards with date of birth is the only sure versa.. I do not agree that the onus be way of telling. put Onto us, unless certificates of some Change the legislation so that the sort are issued and even then some emphasis & onus of proof of age is older people are buying for the under where it should be - with the individual 16s. customer & that they cop the It would not matter what age restriction fine/prosecution. Retailers shouldnt be was in place as it is easy to get older meat in the sandwich in this case as we are now.

A number of respondents indicated that raising the age to 18 years would help retailers to determine who was able to purchase cigarettes. The comments of grocery/supermarket retailers included:

Yes, most definitely. Yes - age restriction to 18 would stop Yes, raising the age restriction. young ones buying cigarettes for that Yes, that would help retailers who sell much longer. cigarettes as they would be looking for Yes - young people should carry ID to more mature person, hence at least less make proof of age easy. chance of selling to under 16 Yes Ido think 18 would be easier. Yes, the 13-16 age group can be very Yes raise age to 18. tricky. Teenage girls are the hardest for Yes raise the age. me anyway. A 15 year girl done up Yes, 18 years old, looks at least 19-20. Yes, age restriction from 16-18 years of Yes. Raising the age to 18 would help a age would be good idea. lot that way we can be sure they are at Yes, at present we do not sell cigarettes least 16 years old. to students in school uniform.

197 Yes, but even then you would still have The comments of dairy retailers were problems, but it would definitely make as follows: things easier. Yes - as this would mean most secondary school students would not be Yes, raising the age restriction would be able to buy cigarettes. a big help. Yes it would help to raise the age Yes, raising the age to 18 years. restriction from 16 to 18 years. Yes, if it was 18 it would make it easier Perhaps, at the moment all you can do to cover the 16 mark Not so much the is ask if they are 16, if they say yes, then male as the females, when dressed up the onus is on them. and lipstick and make-up on, makes it Sometimes yes! because some boys at very harcL Just like in a pub situation. high school are Very big"! Yes, I still feel raising the age to 18 Yes - 18 years restriction good idea and years., is another way of delaying the a law that 16 year olds cant buy age limit on smoking. cigarettes/tobacco in a school uniform.

One concern that has been the sale of cigarettes to persons under 16 years of age who have notes from their parents or who have adults waiting for them in a car outside the shop. In both cases the customer (under 126 years of age) indicates to the retailer that the cigarettes are for someone else. Retailers were asked if they thought this practice took place. Their views are presented in table 4.13 below.

Table 4.13 Do you [retailer] think retailers sell cigarettes to children under 16 years of age with notes or who have parents in a vehicle outside the shop?

N % (N) % (sample)

Yes 530 53.1 52.1

No 225 22.5 22.1

Dont Know 235 23.5 23.1

Sometimes 18 1.8 1.8

N 998

Just over half the respondents considered retailers did sell cigarettes to under 16 year old customers if they had a note or had parents waiting in a vehicle outside the shop. A quarter didnt believe this happened and another quarter of the respondents didnt know if this practice took place. Figure 4.11 illustrates some consistency with this view across the length of time retailers have been at the current business address. For example, just over half the "new" retailers thought

198

Figure 4.11 Do retailers sell cigarettes to minors with notes or with parents waiting

outside the shop?

percent respondents 70 - 60-...... 1 --...... I...... I I. 50- j I

I__i 1

10_ I_ I I - 0 - .L-.- -.-.-.- < 1 yr 1-2 yrs 2-5 yrs 5+ yrs D/K 21.3 20.9 26 23.4 No 23.2 18.3 17.7 29.9 Yes 55.5 60.7 56.3 467 length of time at current business

D/K __ No P !Yes

199 this practice took place in comparison with just under half of the "established" retailers.

Given that three out of four respondents in our sample thought the practice of selling cigarettes to minors with a note or parents waiting outside the shop either happened or didnt know if it happened, then there is a strong need to provide retailers with information to inform them that this practice is prohibited under section 30 of the Smoke-free Environments Act 1990. 4.4.7. Support and assistance needs of retailers The respondents made a number of comments regarding the support and assistance they would like the Department of Health to provide. Their comments were divided into a number of categories. A number of retailers said they wanted more information. The comments of the grocery/supermarket retailers included:

More information especially to staff on passive smoking. We need to make smoking more anti-social. 1. More information leaflets and More information for staff and posters amongst high school students to customers about health risks etc. prevent them from starting to smoke! 2 Parent information. Stickers/posters to go on shop Up to date information of what are the windows/walls restricting the use of requirements. smokes. Updated information posted out from A more detailed understanding of the time to time pointing out any changes law; not complex written information. to the law and reinforcing what is Information about danger of smoking already law. cigarettes to give to customers. We had a lot of difficulty obtaining Information about the legislation that stickers etc for a smoke-free affects us show owners in a pamphlet environment and little or no setting out guide-lines we have to abide information on advertising. by. And updated information as it We have good support and comes to hand. information. Information and strict guide-lines - Written info outlining the main points easy to follow. Signs as indicated in 6. of the legislation as it relates to retailers Information that is easy to understand. eg list points say 1-10. Do not bring in Just more general information as new 2-3 pages of general information. owners.

The comments of dairy retailers about wanting to receive more information on the Smoke-free legislation included:

Provide us with legal rights On-going information to the general information. U public. Also, if it is an offence to supply More information on the act and a few tobacco products to persons under 16 reasons. years of age, it "should also be an Information about the restrictions to U offence to buy them" if youre under 16 the children under 16, including all years old. retailers. sometimes retailers receive Provide information re: sale of nasty abuse from under 16s for not U cigarettes/tobacco to persons under 16 selling cigarettes to them. Is there any Provide us with printed information. protection for the retailer there? There should be stricter etc...... U 200 To keep us fully informed of "all" reluctant to pass on information: or changes in government law, rules and just dont know. legislation by post stickers to warn off Advise, inform and instruct parents would be under-age purchasers, etc. who smoke, not to send their kids to A lightweight negative brochure have the shop to buy cigarettes. been provided in the past. We want I find (area health board) gave us all info sent automatically every 1-2 years information requested as diary owner sell every 2-3 years. Info To be kept up with current laws and with examples of legal sales & illegal information. sales. Info packs readily available at Information regarding the law as it cigarette wholesalers. stands for sale of tobacco products. To inform the public fully on the laws Written information in plain language and penalties relating to the purchase on what the law actually is, so that and supply of cigarettes, etc. to minors. everyone has the same interpretation. Give all necessary information about Mainly to keep us informed on the law. changes. In store, no smoking signs More information on the dos and with health warnings. No smoking donts. signs, with reasons why. Tobacco sales, More informal-ion in newspapers or t.v. stop pushing for counter display on new on the law and fines for smoking in brands of cigarettes. shops. some shops let people smoke. To forward relevant information When I tell people they are not to regarding the smoke-free legislation. smoke they get quite rude. Information outlining relevant law to Provide larger signs regarding sales to retailers in lay mans terms. under 16 year. olds. Also could provide Regular updates and reinforcements of information to give to customers the law, "clearly" spelt out not in legal regarding the law and fines etc, that the terms. Sometimes parents may ring to retailer is risking if they sell them to say they want a kid to pick smokes up. under 16s. is this illegal? We are new to business, 2110192, and At this stage basic information as I all information has been gathered by have only been in business three and a phone or verbals from representatives. half months. Find some Departments. lack or

A number of retailers indicated they wanted the Department of Health to provide them with signs. Some of the comments from the grocery and supermarket retailers included:

Large No smoking signs and larger Compulsory ban on smoking in every signs stating penalties. Perhaps there shop or mall and signs to say smoke should be a penally to the offending free zone or similar. It should also be parents also. strictly policed with heavy fines for Large signs with the penalty for us ignoring notices. It must also be displayed so parents realize our nationwide not just random malls, position. shops etc. More signs or logos reminding shoppers Could you please send me a sticker and staff about bad effects of smoking indicating that i cannot sell cigarettes and age limits. or tobacco to persons under 16 years & Multilingual signs saying smoking a no smoking sign which is so legible to prohibited within the store eg Fijian, be able to be seen by everyone who Samoan, Nivan.. etc. come to my shop. Thank you. Official visit and signed licence saying Information and strict guide-lines - you comply with instore stock display easy to follow. Signs as indicated in 6 as per advertising e.g. like food licence

201 II per district counciL Not such a heavy 1995. Get more to the young kids and harsh penalty against retailers. before they start smoking - attack 11 Contrary to liquor advertising-just as negative peer pressure. More anti harmful to innocent smoking posters/signs. Pamphlets, written material, signs for Signs which point out that smoking in cafeteria. foodstores is illegal for every smoker II Print in larger letters on all notices for not just this other person. As most display in public places and shops BY seem to think that our signs apply to DEMAND OF THE SMOKE FREE every other smoker but not them. Signs II ENVIRONMENT ACT We find in Samoan language would help. smokers ignore our numerous signs and Small check-out signs re age. think we make the rule hence we lose a Some no smoking signs if possible (just II customer who wont then every buy two small ones). other We all understand the age limit but are Providing a sign that says if you look 16 unclear on the sign age requirements or younger but you are not, do not be and the smoke free legislation. Maybe UI offended if asked for ID. more frequent newsletters. In general - ban sponsorship of sports activities by tobacco companies before II The comments by dairy retailers about receiving signs from the Department of Health included: [] More nationwide coverage of the It is extremely difficult at times to pick problem. More prominent display signs. peoples ages. When we are busy, we More complex signs explaining the have to take peoples word of their age criteria and the fines that go with the & Im sick & tired of arguing the point restrictions. if they havent got their ID. The sign/sticker saying no sales to Provide larger signs regarding sales to persons under 16 years could be under 16 year olds. also could provide enlarged, say twice the size it is now. information to give to customers the "assistance" should be given to the regarding the law and fines etc, that the youngsters-they are the target, surely. retailer is risking if they sell them to Ideally, no-one under 16 would ask for under 16s. cigarettes. Ready reference material in the form of Smoke-free zone poster; larger signs- a booklet outlining a) legislation "lOx"; "no smoking signs all free of detailing relevant acts; b) obligations of charge to encourage the display of the the retailer & staff c) safely net for signs. Signs showing healthy people retailers who have sold products to Playing sport, cricket, rugby, soccer etc. anyone who has obviously been not just "worded" signs. assigned to entrap retailer, eg: 15 year Bigger signs about not selling to under old 16 years., and educating parents that pamphlets showing actual cancer try and get you to sell them to your diseases to put people off smoking. children. Put on the sign the amount of We would like signs that make the the cost of the fine to the retailer. legislation clear to all customers and A printed sign by the board stressing the the fines applicable to customers as fact that unless ID is produced, welL Make their parents responsible as retailers have the right to turn away welL Many parents buy cigarettes for suspected people who are underage. their kids & hand them to them in front Also it should state the consequences if ofyou.. caught. Why are the retailers subject to fines if cigarettes etc...

202 Education was another area where retailers thought the Department of Health could be playing a lead role. The comments of grocery and supermarket retailers regarding the use of education to get the Smoke-free message across included:

I think it great the way legislation has to send their children. parent education been introduced as law in our country - do they know that their child under 16 regarding smoking. It is a positive is smoking. forward step & I would love to see even Another issue of notices or stickers as more education in our schools some are becoming rather tally and educating our children of the evils of giving the impression that the law has smoking. Ill be a happy shop... eased on the subject. More education at school level on the We have tried to educate all our dangers of smoking. customers that even a note is Advertising to the general public by way unacceptable by sending home a note of TV and instore pamphlets. Self explaining the law; exception to the rule adhesive stickers to attach to cigarette has been knowledge of disabled parent. dispensers. Pamphlets for staff Perhaps a TV advertisement explaining education. the law to adults would be appropriate Educate kids smoking is not good for A campaign directed at school kids. At health or pocket. You will never stop it school informing them it is illegal to but you can slow it down. More p buy cigarettes ifyou are under 16 pamphlets might help. Quarter of my More education to the generalpublic. income is made through tobacco. I Better educate the population with dont want to see smoking cease. Just hazards to "smoking" & drugs in make sure people know they risk general so that the value judgement is 1. Very strong education policy in not left in the retailers hands. They schools. 2 Some parents need similar are not the guardians of societys education as well! morals & can not & should not be held Educate people about the sale and responsible for checking societys consumption of cigarettes - its effects. behaviour... Public awareness of the laws as they relate to retailers ie tell the parents not

Dairy retailers views about education included the following comments:

More education of the public. temptation is greater if everyone and They should educate children at everything says its not allowed or its primary level about dangers of smoking bad to smoke, but "dont push too and arrange lectures at different hard schools regularly. Education for the parent who sends the I would like it more widely known to children in to buy tobacco. Help to the general public that the retailer can soothe my nerves after being verbally be prosecuted if they sell cigarettes to abused by the parent of the child I underage persons, regardless if they rejiised to serve. have a note of their parents are sitting Keep things simple. There are too many in a vehicle outside the shop. dos and donts. Target the young - Educate people about rules for educate them. No point in increasing cigarette purchasing and where not to prices everytime. smoke. We found people started this Require more public advertising to try year to smoke in shop although we and educate the adult smokers "not" to have notice from W CC not to do so. smoke in smoke-free shops. As we have Just educate at school the dangers and several "no smoking" signs in our shop not around every corner as the

203 II but they still insist in smoking in the shop. II General comments from grocery and supermarket retailers about what support and assistance they would like from the Department of Health included: U More anti-smoking advertising on TV Cigarette packs could contain more More education at school level on the damaging warning than the present dangers of smoking. one. Also implement different wording More education to the general public. on the pack from time to time so that More public awareness about retailers they do not become meaningless responsibility. Its tough out there to get slogans. customers without forcing them away I think if the Dept of Health spent all to competitors that dont mind them the money that goes into this kind of smoking in their stores or who are too thing in more needy areas it would be a weak to ask them to stop. better thing. I think all smokers need to More written material & pamphlets for be taught is consideration for others. distribution to staff. We pay now for our health care and we Spend time in large volume only destroy supermarket to become more closely I think the campaign is working. I note acquainted with the new problem people giving up smoking and many aspects of legislation imposed more are strongly anti smoking and restrictions, they have not worked in the cigarette sales are slowing. past, unlikely to work in future. Make the public more aware of the law The more public awareness of the so we do not have to be the policemen.. legislation is made the better for all More advertising advising general concerned. public & parents that it is against the Try to ensure the manufacturers of law for retailer to serve kids even if cigarettes only package them in parent outside shop in car. minimum packs of 20 by having them More advertising to the public. in smaller packs like 15, 14,10 they More advertising, more awareness to make them more affordable for young the public as well as retailers get people. abused by customers who are not We all understand the age limit but are aware of the law. unclear on the signage requirements More anti-smoking education, TV ads and the smoke free legislation.. Maybe etc. more frequent newsletters.

General comments from dairy retailers about would support and assistance they would like from the Department of Health included:

More publicity about our requirements The Department of Health should give under the law so that the public dont more stickers warning not to smoke in think that it is just us, as retailers, the shop and also not to sell smokes to making the rules and punishment for I underage kids. those retailers who break the law. they I would like it more widely known to make it hard for the ones enforcing it. the general public that the retailer can More lectures to the school kids so II be prosecuted if they sell cigarettes to when they come into the shop to buy underage persons, regardless if they cigarettes they know they are breaking have a note of their parents are sitting the law and we can read their faces (in 11 in a vehicle outside the shop, generally most cases!) speaking etc...... II [Ii

204 ii More advertising telling parents so we companies are making on a packet of dont appear to be the ones making the cigarettes-currently 11.71% pathetic!! decisions. Advertise more nationally that smoking More advertising, emphasising the age is forbidden in shops that sell food. We restriction, and to provide more have a lot of inconsiderate people material for Youths" on the fatal come into our dairy holding a cigarette. diseases, tobacco can cause. Smokers need to be made aware that More explicit notices for display in the smell of smoke to non-smokers is retailing outlets. repugnant. Make the public more aware of the By asking the Government to ease the regulations, so that when we do refuse restrictions inside shops. By adhering a minor, the person does actually know more controls only makes it more why. Perhaps more newspaper difficult to provide the service to the advertising or pamphlets are necessary customer, it looks like stock will to achieve this. eventually be out of sight, creating store More advertising on what shopkeepers & stock problems. arent allowed to do to get through to More about the law about cigarette "thick"parents. sales on TV, law that you must have There is no regulation in India about "ID" if asked about age; law that you selling cigarettes to underage, but I must have the sticker up about cigarette myself have never tried to smoke. More sales. freedom people bother less. More Legal position of retailer to be more regulations kids are going to smoke definitive to parents who ask children more. You cannot stop them. to buy their cigarettes for them. More advertising of all rules to go to 1) stickers & literature re:legislation schools to stress the rules and to make (which stinks anyway) as is presently sure kids and parents understand no done is fine; 2) the health people have sale at "all" to under 16 year olds. more important things to do than run Total ban of all cigarette smoking until around after the whims of politicians; the year 2050 so I can breathe fresh air. 3) the public as individuals should bare Give the retailer a chance to make the responsibility etc...... more profit than the cigarette 4.4.8. Information needs of retailers

Retailers were asked would information they would like the Department of Health to provide regarding the Smoke-free legislation. A number of retailers indicated that they would like further specific information on the Smoke-free legislation. The comments of grocery and supermarket retailers are as follows: Affects on non smokers and legal Our legal obligations. obligations associated to this - plus Since the legislation. we have updates on court proceedings of cases experienced more proliferation of where applicable. cigarette brands, size, variations & sales Any changes in legislation. of "smokes DOH should look into Copy of advertising legislation; stickers; providing more public education type pamphlets. of material which would not offend the Copy of appropriate legislation. "customer" but still put the message Copy of legislation- across. Current legislation and updated Summary of new legislation. information. The actual details of any legislation Leaflets etc outlining the anti-tobacco that is passed. legislation. The Health Dept should provide a Legal requirements in plain English summary of all the legislation. that signage. involves the regulations on age, smoke-

205 II free environments and cigarette ads so in one handy booklet. that the retailer has all the main points What legislation means to us. II

The comments of dairy retailers regarding more information on the Smoke-free legislation are as follows: [I

More information on the smoke-free customer leaflets for customer legislation, how it affects the retailers. knowledge. II I understand the legislation. The Full copy of smoke-free legislation. Health Dept. must get anti-smoking All information related to the smoke- messages into schools and into free legislation. II social/cultural clubs, where children The smoke-free legislation in a simple mix with each other. format. Basic legal information. What the present law is regarding Provide us with legal rights tobacco. Companies legality on I information. tobacco posters and signs which they Information regarding , how to sell put inside the shops, as I removed all cigarettes and tobacco to customers outside stands. UI legally. More updates of what and where the A plain English copy of the current legislation is at present and future legislation, condensed, plus any further proposals for changes. II amendments that come along. Up to date information on new Precise information and knowledge legislation and law changes (regularly) about smoke-free legislation. Also I

The respondents made a number of general comments regarding the information they would like the Department of Health to provide. The comments of grocery and supermarket retailers included:

Precise information on what one can or A regular reminder of the consequences cannot have displayed in a shop - of selling cigarettes to a person of less cigarettes or signs. than 16 years of age & big visible Signs - make available more posters & stickers stating the law ie information on the effects smoking cigarette selling to persons under age of does to your health. 16 Poster informing customers that Updated information posted out from smoking is not allowed in time to time pointing out any changes Any information at all available that to the law and reinforcing what is involves us as a retailer on the already law. requirements and standards. Written information with regards to sale Information and strict guide-lines - of cigarettes and leaflets. easy to follow. Signs as indicated in 6 Since the legislation. we have More indoor information. experienced more proliferation of More information especially to staff on cigarette brands, size, variations & sales passive smoking. We need to make of "smokes DOH should look into smoking more anti-social. providing more public education type More information on the act ie a short of material which would not offend the condensed summary. "customer" but still put the message No amount of information is any across. substitute for abusive behaviour experienced on daily basis.

FM Dairy retailers general comments about their information needs included: More information on the smoke-free Information for young to arrange and legislation, how it affects the retailers. provide their own smoke-free Information about whats going on in entertainment. council on the topic of smoking and All information about selling tobacco also let us know the rules and and smoke-free policy including shop regulations. owners right to decline or sell cigarettes The full amount of infonnation to person under 16, ie: what sort of available as there are a lot of dark rights shop owner has? areas. All information available would be Just TV and radio and newspaper appreciated. coverage. More discussion in schools. More age Nil. Tobacco companies are providing restriction stickers sent out to retailers this information. It costs money to to be displayed. double advice and service. More informnation about display of smoke products in shops. More statistical data

4.4.9. Retailer perceptions of the requirements of the Smoke-free legislation

Respondents were provided with a series of statements relating to the requirements of the Smoke-free legislation and were asked if they agreed, disagreed or didnt know if the statements reflected the intention of the Smoke- free legislation.

Table 4.14 below presents the views of respondents regarding the requirement that no new tobacco product advertisements may be put up in or outside shops.

Table 4.14 No new tobacco product advertisements may be put up in or outside shops.

N % (N) % (sample)

Agree 521 53.1 51.2 Disagree 363 37.0 35.7

Dont Know 98 10.0

N 981

Just over half the respondents agreed with the statement that no new tobacco product advertisements may be put up in or outside shops. However, over one

207 third of the respondents (37 percent) believed they could put up new tobacco product advertisements. More grocery and supermarket retailers (61 percent) agreed with the statement in comparison with 47 percent of dairy retailers. Dairy retailers (42 percent) were also more likely to disagree with the statement in comparison with grocery and supermarket retailers (30 percent). Again, "established retailers (59 percent) were more likely to agree with the statement in comparison with "new" retailers (45 percent), see figure 4.12 below. Clearly, there is a need to inform retailers, especially new dairy retailers, that they are prohibited from putting up in or outside shops new tobacco product advertisements.

Retailer comments about new tobacco product advertisements not being able to be put up included:

Disagree/think the question means ads musn t be seen from outside the shop. Grey area. I know this is correct but do not necessarily agree. My shop my choice. Not government. Only pricing information may be displayed. Disagree - dont mean outside. Dont agree for inside. Disagree - wording changed to include ... may be put up in or not outside shops. Only for a limited time ie 2 months. Retailer views regarding existing signage are presented in table 4.15 below.

Table 4.15 Existing tobacco product signs with health warning messages can stay up to 1.1.95.

N % (N) % (sample)

Agree 573 58.5 56.3

Disagree 306 31.2 30.1

Dont Know 102 10.4 10.0

N I]

AiI Figure 4.12 No new tobacco product advertisements to be put up

percent respondents

< 1 yr 1-2 yrs 2-5 yrs 5+ yrs Agree 44.8 53.3 51.5 59.3 Disagree 40 35.4 38.9 33.6 D/K 15.2 11.3 9.6 7.1 length of time at current business

D/K Disagree 1 Agree

209 II

Fifty eight percent of the respondents agreed that existing tobacco product advertismg signs erected before 16 December 1991 and which include health II warnings could stay up until 1 January 1995, provided they were not altered or repaired. But a core of just under one third of the retailers felt this statement was incorrect. More "established" retailers agreed with this statement in comparison II with "new" retailers, although "new" retailers were twice as likely in comparison with "established" retailers to be uncertain about this requirement of the Smoke- free legislation. (see figure 4.13). II Retailer comments included: Disagree/did the national government change this? II If they are up why not leave them up. Dont care inserted. All advertising signs should be banned earlier! Disagree with words but may not be altered or repalred II Unsure of dates. Wording changed to read, but may be altered repaired - agree. All should go. II As the law relates to 1995. If a window is broken I think the status quo should apply. Set a date and take them down. Exterior of shops could become very messy; should be able to be repaired or touched II UP Should be able to be repaired if necessary. It gets tatty and untidy and needs repair. II Just over three quarters of the retailers agreed that tobacco advertising signs without a health warning must be removed, as is shown in table 4.16 below. As can be seen in figure 4.14 that agreement with this statement was consistently high II across years at the current business address. It would seem that this aspect of the Smoke-free legislation is well known by retailers. II Table 4.16 Tobacco product advertising signs without a health warning must be removed

N % (N) % (sample)

Agree 761 77.0 74.8

Disagree 149 15.1 14.7

Dont Know 78 7.9 7.7 II

N 988 I

210 ...... I

Figure 4.13 Existing tobacco product signage can stay up to 1.1.95.

percent respondents

< 1 y 1-2 yrs 2-5 yrs 5+ yrs Agree 56.1 54.9 57.5 62.7 Disagree 27.4 29.7 36 29.9 D/K 16.5 15.4 6.5 7.3 length of time at current business

D/K Disagree [Iii Agree

211 Figure 4.14 Tobacco product advertising signs without a health warning must be

removed.

percent respondents

100 80 60 40 20 0 - < 1 yr 1-2 yrs 2-5 yrs I 5+ yrs Agree 79.5 70.1) 73.2 77.4 Disagree 12.7 15.3 16.3 15.7 D/K 7.8 13.8 5.4 6.9 length of tinie at current business

D/K Disagree 1 Agree

212 — — Forty-five percent of respondents agreed with the statement that all tobacco product advertising signs must be removed after 1 January 1995. However, there was nearly the same percent of retailers (40 percent) who disagreed with this statement. Half the grocery and supermarket retailers agreed with this statement in comparison with 41 percent of dairy retailers. Dairy retailers (44 percent) were more likely to disagree with this statement in comparison with grocery and supermarket retailers (35 percent). This indicates that the requirements of the Smoke-free legislation regarding tobacco product advertising is not clearly understood by a significant number of retailers, with dairy retailers more likely to disagree with the requirements in comparison with grocery and supermarket retailers. Retailer comments regarding the removal of all tobacco product advertising signs after 1.1.95 included: Before zfpossible. Disagree/if they have to go do it now. Iknow. Agree/outside shops. Disagree/should be longer. Earlier. Hope so. Unless there is a subsidy to replace with fruit signs. Wording changed to read ... after 1 January 1995 - too late - agree Wording changed - all tobacco product outside advertising signs Earlier, why wait till then. Stupid thinking. WIL4T IS PACKET, surely the packet itself is advertising-are we to get cigarettes etc in plain wrappers?

Table 4.17 summarises the views of retailers about the requirements that tobacco products can be displayed in a shop as long as they cannot be seen from outside the shop.

213 Table 4.17 Tobacco products can be displayed in a shop as long as they cannot be seen from outside the shop.

N % (N) % (sample)

Agree 463 46.9 45.5

Disagree 415 42.0 40.8

Dont Know 110 11.1 10.8

N 987

Again, there was divided views provided by retailers with this requirement of the Smoke-free legislation. Just under half of the respondents agreed (47 percent) or disagreed (42 percent) with the statement that tobacco products may be displayed in a shop so long as they cannot be seen from outside the shop. Less "new" retailers (35 percent) agreed with this statement in comparison with "established" retailers (48 percent), see figure 4.15. Thus, this aspect of the Smoke-free legislation needs further clarification with a significant number of retailers believing they can display tobacco products anywhere in their shop.

Retailer comments about the display of tobacco products inside a shop so that the cant be seen from outside the shop included: Disagree/what does that mean (outside your shop) Disagree/depends on location of display with respect to the door entrance. Disagree/this is impossible. we would have to paint the shop windows so people couldnt see in, just stupid. My shop place where i like. Should not be displayed inside either. Hide them under the counter like condoms used to? Those days are long gone! Depends on the shop layout. With large plate windows its a bit impossible as well as keeping them safe from shop- lifters- My belief is must not be displayed in the shop. This one is ridiculous. It would mean a lot of structural moving of shop counters etc. Too tough for some main street retailers. If the shop has full glass frontage where are the cigarettes etc to be kept? - use your brain. What afarce! Sheer stupidity.

214 Figure 4.15 Tobacco products may be displayed in a shop so long as they cannot be

seen from outside the shop.

percent respondents

j -1 [)^=-

< I yr 1-2 yrs 2-5 yrs 5+ yrs Agree 35.5 49 50.7 48.2 Disagree 49.7 35.2 40.1 43.8 D/K 15 15.8 9.2 7.9 length of time at current i)USiflesS

1)/K ME Disagree I1 Agree

215 Just under half the retailers agreed with the statement that tobacco product price displays inside the retail outlet must not exceed the size of 3xA4 sheets, as is summarised in table 4.18 below.

Table 4.18 Tobacco product price displays inside a shop must not exceed 297 mm x 630 mm (3 x A4 sheets).

N % (N) % (sample)

Agree 466 47.7 45.8

Disagree 281 28.7 27.6

Dont Know 231 23.6 22.7

N 977

Twenty nine percent of the respondents disagreed with the statement and just under a quarter didnt know if this was the case. Again, this appears to be a requirement of the legislation not well understood by retailers. Retailer comments about the permitted size of tobacco product advertisement price displays inside shops included: Not displayed at all. This should not be up to the shop keeper or staff as we have enough to put up with. None do exceed. Smaller. Shouldnt be any price displays. Probably correct. Only a Government Department could concoct such trivia. Depends on area space along with other products, this is not a priority believe it or not - ex smoker. Irrelevant at all. They should put prices in a big writing outside with warning that you are burning $$ which you would not let your kids do. In total or for each product? No advertising in our shop. Who cares about size - either up or down. Immaterial.

Rose et. al. (1992) reported that 59 out of 88 (67 percent) Wellington dairies in their sample displayed product and price signs. Of these 59 shops, in only 4 (7 percent) were the product and price signs larger than the maximum size permitted under the Smoke-free legislation.

216

I - -- .- - - Table 4.19 below summarises retailer responses to the statement that notices inside a shop can only show what tobacco products are for sale and their price.

Table 4.19 Notices inside a shop can only show what tobacco products are for sale and their price.

N % (N) % (sample)

Agree 663 68.5 65.2

Disagree 209 21.6 PAM

Dont Know 97 10.0 9.5

N 968

Sixty eight percent of retailers believed this to be a requirement of the Smoke-free legislation, while 22percent disagreed. Agreement was consistent across length of time at the current business address, with 72 percent of "new" retailers agreeing with the statement in comparison with 67 percent of "established" retailers. Retailers comments about the criteria for the content of tobacco product advertising notices inside shops included: This is common sense, why would you advertise something you dont have. Disagree/they sponsor sports events. Loaded question.. It doesnt really matter. It doesnt really worry me. Rose et. al., (1992) in their survey of 88 Wellington dairies reported: Thirty one percent of dairies had tobacco products visible from outside of the shop, which is in breech of section 23(1)(a) of the Smoke-free Environments Act 1990

In certain areas of Wellington, tobacco products were visible from outside the premises in over 50 percent of those sampled. Eleven percent of 88 dairies did not display advertisements for tobacco products, while 78 (89 percent) of dames did display signs advertising tobacco products.

Of the dairies displaying tobacco product advertising signs,

217 12 (15 percent) had a health warning on all their signs, 50 (64 percent) had health warnings on some of their signs, and 16 (21 percent) had no health warnings on any of their signs advertising tobacco products. The results of the Rose et. al. (1992) survey therefore showed that 85 percent of the dairies that displayed tobacco product advertisements did not comply with the requirements of the Smoke-free legislation. Rose et. al. (1992) also noted that measured against the four criteria measures they used to assess compliance with certain aspects of the Smoke-free legislation, only 10 out of 88 dairies (11 percent) fully complied with all four criteria being assessed. Or to put it another way 77 out of 88 dairies with not complying with at least one of the requirements of the Smoke-free legislation being assessed during the survey of dairies. The respondents replies to the statement that the shop name cannot include a trademark of the company name of a tobacco product are presented in table 4.20 below.

Table 4.20 The shop name cannot include a trademark of the company name of a tobacco product.

N % (N) % (sample)

Yes 607 62.6 59.7

No 190 19.6 18.7

Dont Know 172 17.8 16.9

N 969

Approximately 60 percent of retailers agreed with this statement with the remainder equally divided between those that disagreed and those that didnt know if this was a requirement of the Smoke-free legislation. Similarly, respondents were asked if they agreed or disagreed with the following statement "a shop can indicate it sells tobacco, e.g., Seymours Tobacconist, but the name cannot be displayed more than twice without a health message". Half the retailers agreed with this statement while the other half were equally divided between those retailers that disagreed and those that didnt know. Retailers comments about the above requirements of the Smoke-free legislation included:

218 Disagree/ridiculous-if my name were Rothman or Winfield I would expect to be able to use it. Disagree/ifyour name is Peter Jackson then you should use it! Loaded question. Dont care. Hypercritical. People do not read health messages. Its removing retailers right to display on letterheads etc. Would it matter.

Retailers replies to the statement that retailers who put up new tobacco advertisements can be fined up to $10,000, if convicted, are summarised in table 4.21 below.

Table 4.21 Retailers who put up new tobacco advertisements can be fined up to $10,000, if convicted

L N % (N) % (sample)

Agree 376 38.4 37.0

Disagree 529 54.1 52.0

Dont Know 73 7.5 7.2

N 978

Only 38 percent of retailers agreed that they could be fined up to $10,000, if convicted, for putting up new tobacco advertisements. There was some variation in response according to length of time at the current business address as illustrated in figure 4.16 below. Whereas only 21 percent of "new" retailers agreed with this statement, 43 percent of "established" retailers agreed with this statement. This is one aspect of the requirements of the Smoke-free legislation that needs further clarification with retailers. Retailers comments about this requirement of the Smoke-free legislation included: Yes/but not this amount Dont know/stupid. Didnt know how much. Wasnt sure. Was aware offine but not aware of amount. But this law has never been enforced. JI7zat about the cigarette companies doing it. Who gets fined then? Yes, but not the value. There was a case in Christchurch last week Not till last weeks publicity.

219 Figure 4.16 Retailers who put up new tobacco advertisements can be fined up to

$10, 000, if convicted.

percent respondents 80-i 70 - 60-

I: ...... J ii LfO- J 30 ] . 20 1 1 1 _ 1.L.... < 1 yr 1 -2 yr 2-5 .vis + \r D/K 9.5 7.6 5.5 7.9 No 69.6 53.3 50.7 49.4 Yes 20.8 39.1 43.8 428 length of time at current business

D/K No ilYes

220 — — — — — — — — — — — — — — — — — — — — 4.4.10. Retail outlet display of signs or posters depicting tobacco sponsored events

Retailers were asked if they displayed shop signs orposters indicating or suggesting sponsorship of sporting or non-sporting events by a tobacco product manufacturer or company. The results are presented in table 4.22 below.

Table 4.22 Retail outlet display of signs or posters depicting tobacco sponsored events

N % (N) % (sample)

Yes 149 15.3 14.7

No 781 80.3 76.8 Dont Know 44 4.5 4.3

N 973

Only 15 percent of retailers indicated they displayed signs or posters indicating or suggesting tobacco sponsorship of sporting or non-events. Dairy retailers (18 percent) were more likely to display such signs/posters in comparison with grocery and supermarket retailers (12 percent). Also, "established" retailers were more likely to display such signs/posters in comparison with "new" retailers. Retailers comments about the display of sponsorship signs included: Dont know/I would like to. Only by tobacco product manufacturer that is within the law. No - absolutely not. On calendars. Not many healthy companies want to sponsor sport.

Rose et al. (1992) reported that 10 percent of their sample of Wellington dairies displayed sponsorship posters, which is slightly lower than the 15 percent reported from our more extensive survey of retailers.

221

4.4.11. Cigarette products sold by retailers.

The dairy, grocery and supermarket retailers were asked to list the type of cigarette products they sold. The results are summarised in table 4.23 below.

Table 4.23 The type of cigarette products sold by the retailers in our sample.

N % (N) % (sample)

1(sin ly) 153 15.3 15.0 2 10 911 91.2 89.6 3 14 641 64.2 63.0 4 15 653 65.4 64.2 5 20 969 97.0 95.3 6 25 960 96.1 94.4 7 1301 761 76.2 74.8 8 cartons 716 71.7 70.4 9 other 81 8.1 8.0 10 cigars 10 1.0 1.0

Only 15 percent of retailers indicated that they sold cigarettes singly. The vast majority of retailers sold cigarettes in packets, with the most frequently sold being: 20s (97 percent), 25s (96 percent), and lOs (91 percent). Cartons were sold by 72 percent of the respondents.

Dairy retailers were more likely to sell up to five different types of cigarette packets in comparison with grocery and supermarket retailers. Whereas a third of dairy retailers sold seven or more types of cigarette packets, over half grocery and supermarket retailers reported selling seven or more types of cigarette packets. This is summarised in figure 4.17 below.

4.4.12. Retailer general comments about the Smoke-free legislation

Retailers made a number of general comments regarding their requirements associated with the Smoke-free legislation. The comments reinforced and added to their comments which have been reported in the report thus far. Their general comments are presented in appendix 5.

222 Figure 4.17 The number of different types of cigarette packets sold by retailers

percent respondents

leiig iii of Lirine at current business

1-5 products 6 products I 7+ products

223 4.5. Summary

Just over half the retailers represented dairies and just under half were retailers from grocery, supermarket or related businesses. Approximately one third of the sample have been a retailer at their current address for more than five years. Thirty percent of retailers have been at their present address between two and five years, with the remaining 37 percent reporting being at their present address for two years or less.

Retailer Smoke-free legislation information sources and content Sixty-one percent of the respondents indicated that could recall receiving information regarding the requirements related to the Smoke-free legislation. However, a significant number, one third of the respondents, indicated they had not received any information.

Two thirds of grocery/supermarket retailers indicated they had received information in comparison with 57.7 percent of dairy retailers. Also, more dairy retailers indicated they had not received information in comparison with grocery/supermarket retailers.

Source of the Smoke-free legislation information. Over sixty percent of the respondents cited the Department of Health as the leading source of information about the Smoke-free legislation. The next highest information source was tobacco companies, with just over a third of respondents indicating they had received information from this source.

Content of the Smoke-free legislation information. Nearly all (92 percent) of the retailers who received information recalled it involved the sale of cigarettes to under 16 year olds. Nearly two-thirds of respondents recalled receiving information about Smoke-free workplace policies. The next most , frequently recalled types of information were: health messages on tobacco advertising signs (56.8 percent) and the display of tobacco products in shops (51.9 percent). Nearly all the "new" retailer respondents (88.2 percent) reported receiving 1 or 2 types of information regarding the Smoke-free legislation in comparison with half of the "established" retailers. The longer the retailer was at the current business the more likely they were to report receiving five or more types of information. This indicates that "new" retailers are exposed to little material relating to the Smoke-free legislation and therefore a mechanism should be developed to inform retailers of their requirements as early as possible.

224 Retailer understanding of the Smoke-free legislation Approximately half the retailers considered they understood the requirements of the Smoke-free legislation and half thought they understood some of the requirements. There is a clear need to update retailers of their requirements. The more experienced the retailer the more likely they were to report an understanding of the requirements of the Smoke-free legislation. Thus, newly established retailers should be targeted to receive information on the retailer requirements related to the Smoke-free legislation.

Retailer Smoke-free legislation information needs Three out of four "new" retailers wanted further information in comparison with half the "established" retailers. Nearly all the respondents indicated they wanted further information in written form. Only 12.7 percent of the respondents wanted a national free-phone or help line and 12.9 percent of respondents indicated they would like a personal visit. Clearly, the distribution of written material to retailers on the requirements of the Smoke-free legislation would be well received, especially by "new" retailers.

Support and assistance provided to retailers regarding the Smoke-free legislation Only a third of retailers indicated they had received support or assistance from the Department of Health and tobacco companies, respectively, in association with the Smoke-free legislation. The "new" retailers were less likely to have received support and assistance from the Department of Health and/or Tobacco Companies in comparison with the "established" retailers. Only 14 percent of retailers indicated they had received support and assistance from area health boards. This is lower than might have been expected given the network of area health board smoke-free co-ordinators that have been established. Sale of cigarettes to individuals under 16 years of age Overall, a high number of the respondents reported that they had received the sticker indicating they could not sell cigarettes or tobacco to under 16s. Nearly all retailers agreed with the statement that they should display a sign in their shop that the sale of tobacco products to persons under 16 is prohibited. Just over three quarters of respondents were aware that retailers who sell tobacco products to people under 16 years of age can be fined up to $2,000, if convicted. However, 20 percent, indicated that they were not aware of this aspect of the Smoke-free legislation. Sixty percent of "new" retailers were aware of the fine, if convicted, for selling cigarettes to minors, in comparison with 83 percent of of retailers. A third of "new" retailers indicated they were not aware of this aspect of the Smoke-free legislation in comparison with only 15 percent of of retailers. While many retailers have received the sticker outlining their legal requirement not to sell cigarettes to under 16year olds, and know that it should be displayed, it is clear from chapter 3 that this alone is not an effective prevention strategy.

225 Rose et. al. (1992) reported that 59 out of 88 dairies (67 percent) in their Wellington sample displayed a sticker indicating the restriction of the sale of tobacco products to under 16 year olds. Of the shops that displayed the sticker, 54 (92 percent) displayed it in a clear and visible manner. Therefore just over one third of the dairies either didnt display a sticker or displayed in such a manner that it could not be easily seen.

Three quarters of the retailers indicated is was difficult for theme to tell if the customer was under 16 years of age. For the majority of retailers there is uncertainty regarding the age of customers, especially determining if they are under 16 years of age. Retailers indicated a number of options would make it easier for them to determine the age of customers, especially those under 16 years of age. The two most frequently mentioned options were the carrying of photo ID cards, and increasing the age of legal purchase of tobacco products to 18 years, although retailer views about this latter option were divided. Just over half the respondents considered retailers did sell cigarettes to under 16 year old customers if they had a note or had parents waiting in a vehicle outside the shop. A quarter didnt believe this happened and another quarter of the respondents didnt know if this practice took place.

Support and assistance needs of retailers

The respondents made a number of comments regarding the support and assistance they would like the Department of Health to provide. Their comments included requiring further support and help in the following areas: more updated information about the Smoke-free 1eislation, more display signs which are larger than presently used, multilingual sins, and further public education of the requirements of the Smoke-free legislation.

Information needs of retailers

Retailers were asked would information they would like the Department of Health to provide regarding the Smoke-free legislation. A number of retailers indicated that they would like further specific information on the Smoke-free legislation, such as, legal information and notification of any changes in the Smoke-free legislation, and compiling the requirements of the legislation into a handbook using plain English.

Retailer perceptions of the requirements of the Smoke-free legislation Respondents were provided with a series of statements relating to the requirements of the Smoke-free legislation and were asked if they agreed, disagreed or didnt know if the statements reflected the intention of the Smoke- free legislation. Their responses are summarised below:

Just over half the respondents agreed with the statement that no new tobacco product advertisements may be put up in or outside shops. However, over one third of the respondents (37 percent) believed they could put up new tobacc product advertisements.

226 • Fifty eight percent of the respondents agreed that existing tobacco product advertising signs erected before 16 December 1991 and which include health warnings could stay up until 1 January 1995, provided they were not altered or repaired. But a core of just under one third of the retailers felt this statement was incorrect.

• Just over three quarters of the retailers agreed that tobacco advertising signs without a health warning must be removed • Forty-five percent of respondents agreed with the statement that all tobacco product advertising signs must be removed after 1 January 1995. However, there was nearly the same percent of retailers (40 percent) who disagreed with this statement. • Just under half of the respondents either agreed or disagreed with the statement that tobacco products may be displayed in a shop so long as they cannot be seen from outside the shop. • Just under half the retailers agreed with the statement that tobacco product price displays inside the retail outlet must not exceed the size of 3xA4 sheets.

• Sixty eight percent of retailers believed that notices inside a shop can only show what tobacco products are for sale and their price, while 22 percent disagreed.

• Approximately 60 percent of retailers agreed that the shop name cannot include a trademark of the company name of a tobacco product. The remainder were equally divided between those that disagreed and those that didnt know if this was a requirement of the Smoke-free legislation. • Only 38 percent of retailers agreed that they could be fined up to $10,000, if convicted, for putting up new tobacco advertisements. • Only 15 percent of retailers indicated they displayed signs or posters indicating or suggesting tobacco sponsorship of sporting or non-events. Finally, retailers were asked what types of tobacco products they sold. Only 15 percent of retailers indicated that they sold cigarettes singly. The vast majority of retailers sold cigarettes in packets, with the most frequently sold being: 20s (97 percent), 25s (96 percent), and lOs (91 percent). Cartons were sold by 72 percent of the respondents.

227 I I I I 11 228 0 Chapter 5 Summary and Conclusions

Causal relationships have been found to exist between smoking and lung cancer, as well as cancers of the esophagus, bladder, kidney, larynx and oral cavity, pancreas and stomach. Eighty-five percent of lung cancer deaths and 30% of all cancer deaths are attributable to smoking.

Maori men and women have one of the highest recorded incidences of lung cancer in the world; 15% of the higher overall total death rate for Maori compared with Pakeha is attributable to higher smoking rates amongst Maori. The lung cancer rate in New Zealand women tripled between 1964 and 1986 and is still rising. Lung cancer rates for Maori women are over four times higher than those of non Maori women, and are the highest in the world.

In New Zealand it has been estimated that each year 4,815 years of working life are lost due to cigarette smoking induced premature mortality (Gray, 1988). Smoking is a major public health problem in New Zealand. Therefore all legitimate means by which smoking initiation can be delayed need to be explored. To achieve this aim it has been suggested that "a comprehensive and well- orchestrated program of education, taxation, and legislation" may be required for success (Stanwick et al., 1987).

5.1 Literature Review Smoking prevalence - International literature Overseas surveys have observed a significant decline in the smoking prevalence of adults, accompanied by a somewhat less striking and more recent decline in the smoking prevalence of adolescents.

These declines in smoking prevalence have been less marked for females than for males, although the disturbing trend for females to have higher prevalence rates than for males seems to be levelling off with recent U.S. surveys identifying few gender differences.

Ethnic differences in smoking have also been identified in both the U.S. and Australia. For example, in the U.S., Whites have been found to be more likely to start smoking earlier, to be more likely to continue smoking, and to smoke more than Hispanic and Black adolescents.

Whatever the reasons for the ethnic and gender differences identified in the United States, Australia and Great Britain, it can be argued that there is sufficient evidence to support the view that smoking prevention, reduction, and cessation programmes will become more effective if they incorporate ethnic and gender factors into their programmes (Rogers and Crank, 1988).

229 Smoking prevalence amongst New Zealand adults One in four adult New Zealanders (25%) in 1990 were smokers with an average consumption of 12 cigarettes a day. Forty-six percent of all New Zealanders had never smoked and 29% were ex-smokers. (Hilary Commission Report, 1991) A 1991 survey (N.R.B., 1991) concluded that current smoking status has changed very little since 1989. In both 1989 and 199123% were found to currently smoke 1 or more cigarettes a day. Fifty-three percent in 1991 reported having never smoked regularly compared with 52% in 1989; and 24% in 1991 reported that they used to smoke regularly compared with 25% in 1989. In New Zealand, cigarette consumption has declined since 1983 but this decline has been more marked for men then for women. Since 1986, the number of women who smoke has remained consistently higher than that of men aged 15-24 years. (Department of Health/Department of statistics, 1992) Recent surveys have shown a decline in tobacco use among Maori men down to 49.4% in 1989 and 45.1% in 1990 suggesting that fewer young Maori men are either taking up smoking or continuing to use tobacco throughout their adult lives (Reid and Pouwhare, 1991). For Maori women, however, there has been no clear evidence that smoking rates are falling: 58.5% in 1981; 62.0% in 1989; 57.2% in 1990. When the two age groups, 15-34 and 35+ were examined it was found that 60.8% of young Maori women and 51.7% of mature Maori women were smokers in 1990. Nearly two- thirds of Maori women being regular smokers during the peak child bearing and child rearing years. These statistics suggested that smoking rates among young Maori women are not decreasing and may even be increasing although mature Maori women appear to be either quitting or dying from tobacco use. (Reid and Pouwhare, 1991)

Smoking prevalence amongst New Zealand adolescents Approximately 50 New Zealand children take up smoking every day (Carr-Gregg and Gray, 1989).

The National Research Bureau surveyed 1600 New Zealand teenagers aged between 10-15 years in 1989 and again in 1991 (N.R.B., 1989; 1991). In 1991 it was found that while only 4% (5% in 1989) were regular smokers, a further 25% said that they had experimented with cigarettes to some degree, most only trying them once. It was found that after age 13 there is a sharp rise in the uptake of regular smoking. Those who smoked regularly in 1991, were smoking, on average, about half a packet a week (10.9 cigarettes on average). Like the overseas research, New Zealand studies have also found females to be taking up. smoking in greater numbers than males. A survey of 10-15 years in 1989 and 1991 (N.R.B., 1989; 1991) found that experimentation was more likely among Maori than among Europeans or Pacific Islanders. II II

230 II Significant numbers of New Zealand adolescents are still continuing to initiate and maintain smoking behaviours. It appears that females and Maori are at particular risk prompting the need for prevention programmes to be sensitive to both gender and ethnic differences if any significant changes are to be made to the smoking prevalence rates of New Zealand adolescents.

Why do young adults initiate and maintain smoking behaviours? The smoking onset process may be viewed as a series of stages starting with preparation and anticipation, and moving to initiation, experimentation, and lastly to the maintenance of regular smoking (Best et al., 1988). Adolescent smoking uptake and maintenance has been associated with a number of factors which can be grouped under eight main headings: • Peer group smoking behaviour • Family smoking behaviour • Knowledge and attitudes about smoking • Demographics • School related factors • Personal factors • Advertising • Availability

Miller and Slap (1989) argued that "the weight of the literature supports a strong and consistent association with adolescent smoking for only three variables: parental smoking, peer smoking, and sibling smoking". Reid (1985) also stated that the main influences are adults, especially parents, followed by peer influence, and then by school policies, including smoking by teachers. Best et al. (1988) suggested that the relative influence of different factors vary according to smoking stage. They argued that demographic and social influences are important in the early stages of smoking, but as experimentation becomes more frequent, psycho-social factors have a developing impact; with the final transition to regular smoking being more pharmacologically based as the nicotine dependence develops.

During the transitional period between childhood and adulthood, adolescents are trying to disentangle themselves from the influence of an identification with their parents; establish stronger links with their peers; and establish a sharper and more independent self-identity. "Smoking is a symbolic vehicle for many of these efforts" (Syme and Alcalay, 1982).

The factors which influence smoking uptake and maintenance by adolescents must be addressed if we are to prevent children from taking up smoking.

231

Smoking prevention - International and New Zealand The central aim of public policy in the control of cigarette smoking should be to minimize the health damage of cigarette smoking, with a secondary aim being to minimize the economic dislocation resulting from the achievement of this health goal (Breslow, 1982). Intervention strategies focus on either changing the individual or changing the environment in which the individual operates: 1. Individual:

(i) school education programmes for both prevention and cessation of smoking; (ii) media campaigns, for example, anti smoking advertisements. 2. Environmental: i) restricting the sale of tobacco to minors; ii) taxation of tobacco; iii) banning cigarette advertising; iv) limitations on where smoking is allowed; Macfarlane (1993) argued that school health education programmes are unlikely to work on their own and suggested therefore that such programmes need to be part of a concerted effort by the government of the country to take responsibility for health promotion through the enactment and enforcement of effective laws (for example, prevention of cigarette sales to minors, cigarette advertising bans). It should be remembered that youth who have the highest tobacco use rates are usually among those least likely to be reached through school based programmes. Therefore other channels may be needed to reach these high risk youth: parents/family; mass media; marketing/advertising agencies; law enforcement agencies; peer leaders/community leaders; schools (early grades, policy enforcement, instruction, referrals); workplace; unemployment agencies; local/ state/ federal government agencies; drug treatment programmes; boys/girls clubs; youth service bureaus; neighbourhood centres; social service agencies; fraternal organizations; church groups; planned parenthood clinics; maternal and child health clinics; physicians/ nurses/ health clinics; native American reservations. (Glynn et al., 1991)

The broader message environments in which people live are important in the initiation, experimentation and maintenance of smoking behaviours (Wallack and Corbett, 1987). The use of mass media can create climates of opinion, present broad messages, and provide an umbrella for more personal educational activities (Farley, 1991).

Media campaigns can help to create a milieu in which tobacco use is no longer the norm, thus facilitating change among users and discouraging adolescents from beginning to use tobacco. (Novotny et al., 1992)

232 WHO (1990) suggested that novel ways must be found to present information. They cite Richard Petos calculation on British male smokers:

"Out of every 1000 young males who smoke at least a pack of cigarettes a day: one will later be murdered; six will die in a traffic accident; 250 will die before their time from the effects of smoJdng" Cummings et al. (1991) stated that "the mass media play a critical role in influencing what society knows, believes, and does with respect to tobacco use". Therefore we must increase the publics exposure to pro-health anti-tobacco messages by the use of such tactics as: counter-advertising; public relations events (for example, Great American Smokeout or tobacco awareness weeks); and advocacy, that is, using the media to promote public debate about the tobacco issue.

Restricting access to tobacco One solution to the problem of adolescent smoking is to restrict childrens access to cigarettes thereby reducing consumption of the product and, ultimately, damage to health. Easy access to tobacco is a prerequisite to maintaining a tobacco addiction. If minors have difficulty in obtaining tobacco, they may be prevented from experimenting with and later becoming addicted to it (Altman et al., 1989; Davis, 1991).

Numerous studies have demonstrated the great ease with which adolescents can obtain tobacco despite legislation being in place to prevent them from doing so. Such studies have been conducted in two main ways: direct estimates and self- report estimates. Altman et al. (1991) argued that it is important to combine education of retailers and the public with the "bite" of enforcement. It is suggested that communities will respond more favourably to enforcement measures if educational interventions are implemented first.

Since most adolescents have minimal purchasing power, it has been argued that increasing taxation on tobacco may be an effective way of combating teenage smoking (Novotny et al., 1992).

A number of researchers have found evidence to support the view that if taxation on tobacco is increased, then consumption decreases (Roper, 1991). Price has been found to be an important motivating force in the New Zealand market with the impact of punitive levels of taxation having far more of a depressing effect on the market than advertising bans or other government restrictions (McLoughlin, 1990). It is important to remember that if increased taxes on cigarettes are to be effective, these taxes must maintain realvalue,thatis, 25 cents/pack in 1987 will not be the same as 25 cents/pack in 1993.

233 Banning cigarette advertising The extent to which cigarette advertising contributes to increases in smoking has been hotly debated by public healthprofessionals and the tobacco industry. Research suggests that there are significant relationships between measures of advertising and smoking. In recent years, many researchers have called for the banning of all forms of cigarette advertising, especially that which targets women, minorities, the poor, and the young (Reid, 1985; Chetwynd et al., 1988; Can-Gregg and Gray, 1989; Armstrong et al., 1990; Cotton, 1990: Pierce, 1990; Roper, 1991; Vickers, 1992; WHO, 1990). Legislative measures to reduce the effects of cigarette advertising should be an essential part of any multiple intervention strategy which aims to prevent the uptake of smoking by adolescents, especially for high risk groups such as female adolescents and adolescent Maori. As Tye et al. (1987) point out: The consequences of tobacco induced diseases are enormous human suffering and social cost. The evidence linking advertising and promotion with increased smoking, and the resulting disease and death, is sufficiently compelling to warrant that it not be permitted by our society The Toxic Substances Board in 1989 argued that a comprehensive policy (raising tobacco prices, public education regarding the health hazards, and a total ban on tobacco promotion) was essential to minimising per capita tobacco consumption and the uptake of smoking by young people.

5.2 Student smoking survey. A sample of 890 school children between the ages of 12 and 17 years from 14 schools around New Zealand took part in a questionnaire survey of smoking behaviour. Sixty-nine percent of the sample were Pakeha, 16% were Maori or part Maori. Fifty-seven percent of the sample were female, and 42% were male.

Age

At the time of the survey, 70% of both males and females in the sample had smoked at least one cigarette. For those who had tried smoking, 20-30% did not smoke again after their first cigarette, 30-40% smoked occasionally, and 30-40% smoked "Lots of times".

Of the 13 year olds, 46% of the females and 38% of the male had tried smoking. For both sexes 80% of 15, 16, and 17 year olds had tried smoking. Both males and females were more likely to have tried smoking as they got older, but the overall percentage smoking "lots of times" increased with age for females but not males. Current smoking status results indicated that the younger students were more likely to have never smoked and the older students were more likely to currently smoke 10 or more cigarettes, half a packet, a week.

234 The figures suggest that if the subject has not tried smoking by the age of 15, he/she is less likely to start, but unfortunately the age related data in the survey are compromised by the nature of the sample i.e. all school children. However, there is a group of individuals, around 20 percent of our sample, who have not smoked by the age of 17 years. It is important to determine what factors contribute, influence and maintain the non-smoking status of these adolescents. For example, our results suggested that the act of trying the first cigarette is the important one in determining smoking behaviour thereafter.

Gender

In our sample, slightly more females than males had tried smoking. Of those who had tried smoking, more males (60%) than females (45%) had stopped smoking by the time of the study.

There was no statistically significant difference between the sexes at the thirteen year old level, but as age increased, females showed a significant increase in smokin behaviour in comparison with males. Three times as many females in companson with males continued to smoke after their first cigarette. In the 16-17 year age group, 39% of the females and 24% of the males had smoked "lots of times": (26%) of females vs. 11% of males became "regular smokers". Thus in our sample, smoking clearly increased with age among females, but such an increase was not so apparent for males. Twenty percent of females in comparison with nine percent of males currently smoked more than 10 cigarettes a week.

Ethnicity

The total number of Maori in the sample was small relative to Non-Maori. Over 80% of both male and female Maori had tried smoking compared to 70% of Non- Maori. More Maori smoked regularly than Non-Maori, but closer examination indicated that this difference was for females only. Sixty-five percent of Maori females had tried smoking compared to 16% of Non- Maori females. Fifty-five percent of Maori females vs. 35% of Non-Maori females were current smokers. Forty percent of Maori females were "regular smokers" compared to only 15% of Non-Maori females. Among Maori in our sample, four times as many females (40%) as males (10%) were "regular smokers". Among the Non-Maori, females again smoked significantly more than males, but the difference was relatively small. For males in our sample, there was no difference in smoking behaviour between Maori and Non-Maori.

I 235 Area

Subjects of both genders and both ethnic groups smoked more in the Hawkes Bay sample than in the other areas, although not all differences reached statistical significance. These differences may be attributable to the geographic location, but could just as easily be the result of differences in the socio-economic status of the schools catchment areas or even the result of non-homogeneous selection procedures for students between one school and another.

Source of cigarettes

The majority of subjects in our sample either purchased their cigarettes themselves or obtained them from friends which is consistent with the previous findings reported by the NRB surveys (NRB, 1989, 1991). Our results closely relate to previous surveys, except there appears to be an increasing use of slot machines from 3% use in 1989 to 9% use in 1993. Female students (54%) are more likely to purchase cigarettes from a shop in comparison with male students (40%). Half the female students obtain cigarettes from friends while a third of male students obtain their cigarettes in this way. As expected, the number of subjects purchasing their cigarettes from a shop increased from 32% for the 12-13 age group to 57% for the 16-17 age group. Maori students were more likely to purchase cigarettes from a shop (64%) and ask their parents for cigarettes (25%) in comparison to Non-Maori students (460/c, 10%, respectively).

A third of 12-13. year olds and half the 14-15 year olds reported they purchased their cigarettes from a shop, thus the legislation seems to pose no barriers to the purchase of cigarettes for a significant percentage of 12-15 year old students. Children in the younger age group were less likely to obtain cigarettes from their parents.

Brand awareness

The most frequently recalled cigarette brand names were: Winfield (cited by 59920 of the sample), Pall Mall (60%), Benson & Hedges (47%), Rothmans(43%), Holiday (32%), Peter Jackson (31%), John Brandon (23%), Camel (13%), Marlboro (11%), and Dunhill (11%).

Brand awareness of Pall Mall, Holiday and John Brandon was higher for females. Awareness of Marlboro was higher for males. The younger age group mentioned Marlboro more and John Brandon less than the older age groups. Pall Mall, Winfield and Rothmans were mentioned more often by Maori subjects: Benson & Hedges and Marlboro more often by non-Maori subjects.

236 It is of significance to note that the major cigarette brand names recalled by the 12-17 sample are also the main brands that sell and the main brands associated with major tobacco sponsorships.

Brand preference Pall Mall (cited by 27% of smokers in the sample), Winfield (26%), Benson & Hedges (15%), Rothmans (13%), Holiday (10%), John Brandon (9%), Peter Jackson(7%), Dunhill (4%) were the brands most "usually smoked" by our sample. 10% preferred tobacco.

More females than males preferred Pall Mall. More males than females preferred Marlboro. Benson & Hedges was identified as the preferred brand by nine times as many Non-Maori as Maori. Less subjects in the Wellington sample identified Winfield as their preferred brand in comparison with the other areas. Conversely more Wellington subjects preferred Pall Mall than in other areas. Note: the Wellington sample was comprised of female students only. It is interesting to note that for the two most popular brands, Winfield and Pall Mall, a brand preference for these cigarettes is evident in the 12-13 year old students. So even at this early age, decisions have been made about which brands of cigarettes are "better" to smoke in comparison with other brands. The cigarette brands that sold the most were also the more preferred by our sample of 12-17 year olds. Again, our survey has shown that 12-17 year old students choose the most "sponsored/advertised" brands to smoke.

Reason for the brand preference

Taste was identified as the main reason for brand preference by 55% of smokers in the sample followed by price (21%). 44% had no brand preference. Association of the preferred brand with either a sporting or non-sporting event was cited as the reason for brand preference by only 3-5% of the sample.

Subjects recording no brand preference declined from 65% in the 12-13 age group to 37% in the 16-17 age group. Older subjects were more likely to cite taste as the reason for brand preference.

Females were more likely than males to cite price as a reason for brand preference.

There were no differences in reason for brand preference between ethnic groups. There were no marked differences in reason for brand preference between the samples in different areas.

237 Brand association In our sample only three brands of cigarettes were significantly associated with sporting events. These were Winfield (cited by 50% of the sample), associated with rugby league, soccer and softball, Benson & Hedges (28%) associated with Tennis, and Rothmans (26%), associated with car rallying, motor cycle racing and car racing. Twenty-four percent of the sample knew that Benson & Hedges sponsored fashion awards.

Activities believed to be Smokefree sponsored were Netball (cited by 31% of the sample), Basketball (19%), and Rockquest (4%). There were highly significant correlations between Brand Awareness, Brand Preference and Brand Association with Sport.

5.3 Retailer survey

Retailer Smokefree legislation information sources and content Sixty-one percent of the respondents indicated that could recall receiving information regarding the requirements related to the Smokefree legislation. However, a significant number, one third of the respondents, indicated they had not received any information.

Two thirds of grocery/supermarket retailers indicated they had received information in comparison with 57.7 percent of dairy retailers. Also, more dairy retailers indicated they had not received information in comparison with grocery/ supermarket retailers.

Source of the Smokefree legislation information. Over sixty percent of the respondents cited the Department of Health as the leading source of information about the Smokefree legislation. The next highest information source was tobacco companies, with just over a third of respondents indicating they had received information from this source.

238 Content of the Smokefree legislation information. Nearly all (92 percent) of the retailers who received information recalled it involved the sale of cigarettes to under 16 year olds. Nearly two-thirds of respondents recalled receiving information about Smokefree workplace policies. The next most frequently recalled types of information were; health messages on tobacco advertising signs (56.8 percent) and the display of tobacco products in shops (51.9 percent). Nearly all the "new" retailer respondents (88.2 percent) reported receiving 1 or 2 types of information regarding the Smokefree legislation in comparison with half of the "established" retailers. The longer the retailer was at the current business the more likely they were to report receiving five or more types of information. This indicates that "new" retailers are exposed to little material relating to the Smokefree legislation and therefore a mechanism should be developed to inform retailers of their requirements as early as possible.

Retailer understanding of the Smokefree legislation Approximately half the retailers considered they understood the requirements of the Smokefree legislation and half thought they understood some of the requirements. There is a clear need to update retailers of their requirements. The more experienced the retailer the more likely they were to report an understanding of the requirements of the Smokefree legislation. Thus, newly established retailers should be targeted to receive information on the retailer requirements related to the Smokefree legislation.

Retailer Smokefree legislation information needs Three out of four "new" retailers wanted further information in comparison with half the "established" retailers. Nearly all the respondents indicated they wanted further information in written form. Only 12.7 percent of the respondents wanted a national free-phone or help line and 12.9 percent of respondents indicated they would like a personal visit. Clearly, the distribution of written material to retailers on the requirements of the Smokefree legislation would be well received, especially by "new" retailers.

Support and assistance provided to retailers regarding the Smokefree legislation Only a third of retailers indicated they had received support or assistance from the Department of Health and tobacco companies, respectively, in association with the Smokefree legislation. The "new" retailers were less likely to have received support and assistance from the Department of Health and/or Tobacco Companies in comparison with the "established" retailers. Only 14 percent of retailers indicated they had received support and assistance from area health boards. This is lower than might have been expected given, the network of area health board smokefree co-ordinators that have been established.

239 Sale of cigarettes to individuals under 16 years of age Policy makers, researchers and the general public recognise the need to limit childrens access to tobacco products by restricting the sale of cigarettes. Overall, a high number of the respondents reported that they had received the sticker indicating they could not sell cigarettes or tobacco to under 16s. Nearly all retailers agreed with the statement that they should display a sign in their shop that the sale of tobacco products to persons under 16 is prohibited. Just over three quarters of respondents were aware that retailers who sell tobacco products to people under 16 years of age can be fined up to $2,000, if convicted. However, 20 percent, indicated that they were not aware of this aspect of the Smokefree legislation. Sixty percent of "new" retailers were aware of the fine, if convicted, for selling cigarettes to minors, in comparison with 83 percent of "established" retailers. A third of "new" retailers indicated they were not aware of this aspect of the Smokefree legislation in comparison with only 15 percent of "established" retailers. While many retailers have received the sticker outlining their legal requirement not to sell cigarettes to under 16 year olds, and know that it should be displayed, it is clear from chapter 3 that this alone is not an effective prevention strategy. Rose et. al. (1992) reported that 59 out of 88 dairies (67 percent) in their Wellington sample displayed a sticker indicating the restriction of the sale of tobacco products to under 16 year olds. Of the shops that displayed the sticker, 54 (92 percent) displayed it in a clear and visible manner. Therefore just over one third of the dairies either didnt display a sticker or displayed in such a manner that it could not be easily seen. Three quarters of the retailers indicated is was difficult for them to tell if the customer was under 16 years of age. For the majority of retailers there is uncertainty regarding the age of customers, especially determining if they are under 16 years of age. Retailers indicated a number of options would make it easier for them to determine the age of customers, especially those under 16 years of age. The two most frequently mentioned options were the carrying of photo ID cards, and increasing the age of legal purchase of tobacco products to 18 years, lthough retailer views about this latter option were divided.

Support and assistance needs of retailers

The respondents made a number of comments regarding the support and assistance they would like the Department of Health to provide. Their comments included requiring further support and help in the following areas: more updated information about the Smokefree legislation, more display signs which are larger than presently used, multilingual sings, and further public education of the requirements of the Smokefree legislation.

240 Information needs of retailers Retailers were asked would information they would like the Department of Health to provide regarding the Smokefree legislation. A number of retailers indicated that they would like further specific information on the Smokefree legislation, such as, legal information and notification of any changes in the Smokefree legislation, and compiling the requirements of the legislation into a handbook using plain English.

Retailer perceptions of the requirements of the Smokefree legislation Respondents were provided with a series of statements relating to the requirements of the Smokefree legislation and were asked if they agreed, disagreed or didnt know if the statements reflected the intention of the Smokefree legislation. Their responses are summarised below:

• Just over half the respondents agreed with the statement that no new tobacco product advertisements may be put up in or outside shops. However, over one third of the respondents (37 percent) believed they could put up new tobacco product advertisements. • Fifty eight percent of the respondents agreed that existing tobacco product advertising signs erected before 16 December 1991 and which include health warnings could stay up until 1 January 1995, provided they were not altered or repaired. But a core of just under one third of the retailers felt this statement was incorrect. • Just over three quarters of the retailers agreed that tobacco advertising signs without a health warning must be removed • Forty-five percent of respondents agreed with the statement that all tobacco product advertising signs must be removed after 1 January 1995. However, there was nearly the same percent of retailers (40 percent) who disagreed with this statement.

• Just under half of the respondents either agreed or disagreed with the statement that tobacco products may be displayed in a shop so long as they cannot be seen from outside the shop. • Just under half the retailers agreed with the statement that tobacco product price displays inside the retail outlet must not exceed the size of 3xA4 sheets.

• Sixty eight percent of retailers believed that notices inside a shop can only show what tobacco products are for sale and their price, while 22 percent disagreed.

241 . Only 38 percent of retailers agreed that they could be fined up to $10,000, if convicted, for putting up new tobacco advertisements. Only 15 percent of retailers indicated they displayed signs or posters indicating or suggesting tobacco sponsorship of sporting or non-events. Finally, retailers were asked what types of tobacco products they sold. Only 15 percent of retailers indicated that they sold cigarettes singly. The vast majority of retailers sold cigarettes in packets, with the most frequently sold being: 20s (97 percent), 25s (96 percent), and lOs (91 percent). Cartons were sold by 72 percent of the respondents.

Compliance with Part II of the Smokefree Environments Act, 1990 The rate of non-compliance with the Smokefree legislation by retailers has been assessed by Rose et. al. (1992) with a sample of Wellington dairies. Twelve of twenty-one Queenstown dairies sold cigarettes to a twelve year old boy (Mountain Scene, 1992). Three Porirua dairies were reported as selling a packet of cigarettes to a eleven year old boy (Te Awa Iti, 1992). Just over half the respondents in our retailer survey considered retailers did sell cigarettes to under 16 year old customers if they had a note or had parents waiting in a vehicle outside the shop. A quarter didnt believe this happened and another quarter of the respondents didnt know if this practice took place. One anticipated effect of the Smokefree legislation, among other things, was to reduce the ability of "minors" (children under 16 years of age) to purchase cigarettes and other tobacco products. To be maximally effective, part II of the Smokefree legislation requires additional enforcement to ensure compliance with the legislation. A number of problems have been identified with the present Smokefree legislation. Problems related to Part II of the Smokefree legislation include:

The language of the Smokefree Environments Act, 1990 The wording of the act has made interpretation unnecessarily difficult. A number of retailers have made comments that they would like further information in plain language about the Act.

An example of the difficulties regarding the language of the Act is provided by the sale of single cigarettes. The sale of single cigarettes is seen by a number of organisations, such as, Action on Smoking and Health, as incongruous with one of the purposes of Part II, namely,

To reduce the social approval of tobacco us, particularly among young people, by imposing controls on the marketing, advertising, or promotion of tobacco products...

The legality of the sale of single cigarettes has been raised by ASH. It would appear that existing legislation does not prohibit the sale of single cigarettes and that the Act will require amendment if the sale of single cigarettes is to be prohibited. It should be pointed out that this interpretation of the Act has not been tested by a court of law.

242 The retailer survey results indicated that 15 percent of retailers sold single cigarettes. It is of concern that this practice might be aimed at children and young adults on limited incomes. This practice by retailers may also be reinforced and influenced by increased tobacco prices and the impact of economic recession.

The "Grandfather Clause" The amendment to section 39 (14 December 1991) allows advertising erected before 16 December 1991 to remain until 1 January 1995, provided it is not altered and complies with the health warning regulations. Advertising that does not satisfy these criteria should have been removed by 16 December 1991. Rose et. al. (1992) reported only 15 percent of the dairies were fully compliant with health warnings on all tobacco advertisements. In our retailer survey, fifty eight percent of the respondents were conversant with this aspect of the Smokefree legislation, although just under one third felt this was incorrect. Because of a lack of enforcement resources, it is difficult to monitor retailer compliance with this aspect of the Smokefree legislation. Clearly, this is an information dissemination and enforcement issue that needs to be addressed.

Enforcement

It would appear that Part H of the Smokefree legislation is not being properly enforced. The enforcement of Part II of the Act is the responsibility of the Director-General of Health. To properly enforce the Smokefree legislation there should be policy direction and funding. The Department of Health should develop and disseminate a policy statement on taking prosecutions under Part II of the Act. The Department of Health should also develop funding arrangements to finance prosecutions under Part of the Act. II

As stated above, the Director-General of Health has the legal authority to enforce Part II of the Act (section 37 (1)). The Smokefree Environments Amendment Bill No. 2 includes provision for this authority to be delegated to area health boards. Implementation of this delegation needs to be seriously considered as central enforcement of Part II of the Act is administratively difficult. The reasons for regional delegation are as follows:

The Department of Health does not have the resources to monitor retailers and gather the appropriate supporting information required for legal action.

Compliance with Part I of the Smokefree legislation has been good largely as a result of the efforts of area health board smokefree co-ordinators. • Area health board smokefree co-ordinators are frustrated at the non- compliance with Part II of the Act but are unable to take legal action as they do not have the authority. Poorly enforced legislation has been demonstrated to inadequately prevent children from obtaining tobacco products (Choi, et. al., 1992). By comparison, implementing enforcement strategies to ensure compliance with legislation has

243 been shown to produce the desired effect (Jason, et. al. 1991). Clearly, the identified problems related to the Smokefree legislation need to be addressed.

If we are to achieve any significant difference in the amount of adolescents initiating (or maintaining) smoking, interventions must not only focus on the individual (smoking prevention/cessation programmes) but also the environment in which the adolescent operates (legislation restricting tobacco access, taxation, advertising bans, anti smoking media campaigns). As Davis (1991) points out the prevention of smoking initiation requires a multifaceted approach that addresses the supply of tobacco, the demand for it, and the environment in which it is used. Therefore

"the programme practitioner and policy-maker must plan with each other in mind. They must focus on individuals, but only as they exist in broader settings such as the schoo4 family, and community. They must also emphasize other broader environments (e.g., marketing factors) that exert significant influence on people choices and behaviour" (Wallack and Corbett, 1987).

A useful framework with which to guide or organize such anti-smoking interventions (both planning and implementation) may the Multi-level Approach toward Community Health (MATCH) framework (Brink et Al., 1988; Simons- Morton et al., 1988; Simons-Morton et Al., 1989). This framework addresses both personal and environmental change by dividing strategies into three levels: individual, organizational, and governmental. Within each level, health promotion activities are organised according to four practice settings: schools, worksites, health care institutions, and communities. An example of this framework in practice might be the planning and implementation of smoking interventions within a school setting:

1. Government regulation of, for example, smoking in schools, curicula components of school health education, tobacco sales near schools, tobacco advertising.

2. Organization school district or school establishment of, for example, smoking restriction policies or bans, smoking prevention and cessation components in health education curicula, school nurse activities in smoking.

3. Individual for example, attendance at smoking prevention or cessation classes, observation of school smoking restrictions. In the prevention of smoking uptake by adolescents, it is important to remember that "individuals do not act in a vacuum; rather, they are greatly influenced by the social environment in which they act" (Thompson et al., 1991). Therefore, the behaviour of the adults around them may be very important in creating anti- tobacco norms. Smokefree policies at school must be followed-up with smokefree policies in the workplace and in public places (Smokefree Environments Act, 1990). Smokers in the adult community must also be helped to stop smoking so as to reinforce anti tobacco norms. As Reid (1985) points out "so long as a substantial

244 number of adults continue to smoke, children will copy them". Therefore interventions, for example, worksite cessation programmes as well as school based programmes may be important. Health education must be directed at both parent and child if any success is to be achieved (Reid, 1986). It is also important to remember that in New Zealand, the subgroups among the young who are most at risk are adolescent females and Maori adolescents. Hence interventions must be sensitive to different cultures within New Zealand society and be gender sensitive. Up until very recently most interventions have not been sensitive to different subgroups and have treated all smokers as if they were the same despite different subgroups having very different reasons for initiating and maintaining smoking behaviour (for example, males - boredom; females - weight loss/maintenance). It is not surprising therefore that interventions to date have had very little impact on female and Maori smoking behaviour. Further research on the characteristics peculiar to these subgroups must be conducted if we are to have a better understanding of the reasons why certain subgroups take up and maintain smoking behaviours more readily than do others. Until we have a clear understanding of the issues involved, interventions will not be effective.

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264 Appendix

The Student Smoking Survey LI ci ci

Student Questionnaire

Stage 11 26 These are some general questions about you.

26a Gender: Please TICK the box that describes you.

i Male [J 2 Female El 26b Age: Please TICK the box that describes you. 1 12 El 2 13 El 3 14 El 4 15 El 5 16 El 6 17 El 26c Ethnic group: Please TICK the box that describes you. 1 EuropeanJpakeha El 2 Maori El 3 Part European, part Maori El 4 Cook Islander El 5 Samoan El 6 Nuiean El 7 Tokelauan El 8 Chinese El 9 Cambodian El 10 Vietnamese El 11 Other ......

.- -.--- .....- 23 Finally, here are some questions about smoking. You dont have to answer any question you dont want to.

Have you ever smoked a cigarette?

I have only ever tried smoking once

I have smoked more than once 1J I have smoked tots of times L1 I have never smoked E1

How many cigarettes do you usually smoke in a week?

I have tried smoking but I dont smoke now I smoke sometimes but not every week Between 1 and 4 a week Between 5 and lOaweek More than iQaweek I have never smoked 111 If you smoke where do you get your cigarettes from? You may need to tick more than one box.

I buy them at dairies I buy them at supermarkets I buy them at garages 1J I buy them at other shops I get someone else to but them for me I get them from my mother or father El I get them from my brother(s) or sister(s) El I get them from my friends El I get them from a slot machine El ifind them El I take/nick them El I have smoked but I don know El I have never smoked I get them some other way - say where or how in the space below hi Write down all the brand names of cigarettes that you know the names of in the space below:

V If you smoke, what brand of cigarettes do you usually smoke?

have smoked but I dont now have never smoked

I usually smoke write in the brand name here:

Vi If you usually smoke one brand of cigarettes, why do you? Tick all that apply. Theyre the cheapest I like the taste Ll Theyre associated with advertising and promotion of a sport event Theyre associated with advertising and promotion of a non-sport event I have no brand preference I don smoke

26 Vii Below is a list of sporting events that are sponsored by cigarette companies. Please Write down the cigarette brand name associated with each sporting event Brand name Rugby league Tennis Softball Car rallying Cycling Soccer Motor car racing Motor cycle racing Harness racing Gallops

II. vi" Please write down the name of any Sports you know which are smokefree sponsored:

ix Please write down the name of any non-sporting (eg, fashion, entertainment, recreation) events you know which are smokefree Sponsored:

x Please write down the name of any non-sporting (eg, fashion, entertainment, recreation) events you know which are sponsored by cigarette companies:

El Appendix 2

Additional demographic information about the sample U

Table A.1 : Gender by Area

Auckland Hawkes Bay Wgton Nelson Canty Not knwn Total

Female Freq. 118 147 63 47 99 23 497 Row % 23.74 29.58 12.68 9.46 19.92 4.63 Col % 54.38 57.42 98.44 49.47 54.10 63.89

Male Freq. 99 109 0 48 84 13 353 Row % 27.97 30.79 0.00 13.56 23.73 3.67 Col.% 45.62 42.58 0.00 50.53 45.90 36.11

Total 217 256 63 95 183 36 850

[Chi-Square p = 0.000 Sample Size = 850 1 Note: No males in the Wellington sample. 9

Table A.2: Age by Area 0 0 Auckland Hawkes Bay Wgton Nelson Canty Not knwn Total

12-13 Freq. 80 43 0 41 0 13 177 Row % 45.20 24.29 0.00 23.16 0.00 7.34 Col.% 36.87 16.80 0.00 43.16 0.00 36.11

14-15 Freq. 101 136 30 54 42 23 386 Row.% 26.17 35.23 7.77 13.99 10.88 5.96 Col.% 46.54 53.13 46.88 56.84 22.95 63.89 0 16-17 Freq. 36 77 34 0 141 0 288 Row.% 12.50 26.74 11.81 0.00 48.96 0.00 Col.% 16.59 30.08 53.13 0.00 77.05 0.00

Total 217 183 95 256 64 36 851

[Chi-Square p 0.000 Sample Size = 851 1 U U 3 JJ

Note: No 12-13 year olds in either Wellington or Canterbury sample. No 16-17 year olds in Nelson sample.

Table A-3: Ethnic Group by Area

Auckland Hawkes Bay Wgton Nelson Canty Not knwn Total

8Maori Freq. 28 71 9 18 1 135 Row.% 20.74 52.59 5.93 6.67 1333 0.74 Col.% 12.90 27.73 12.50 9.47 9.84 2.78

Non- Freq. 189 185 56 86 165 357 16 Maori Row.% 26.40 25.84 7.82 12.01 23.04 4.89 Col.% 87.10 72.27 87.50 90.53 90.16 97.22

Total 217 256 64 95 183 36 851

[Chi-Square p = 0.000 Sample Size = 851]

Table A.4: Gender by Age

12-13 14-15 16-17 Total

Female Freq. 97 234 166 497 Row.% 19.52 47.08 33.40 Col.% 54.80 60.62 57.64

Male Freq. 80 152 122 354 Row.% 22.60 42.94 34.46 Col.% 45.20 3938 42.36

Total 177 386 288 851

[Chi-Square p = 0.407 Sample Size = 851 ]

4 EJ

Table A.5: Ethnic Group by Gender

Female Male Total

Maori Freq. 80 55 135 Row% 59.26 40.74 Col% 16.10 15.54 9 Non- Freq. 417 299 716 Maori Row.% 58.24 41.76 Col% 83.90 84.46

Total 497 354 851

{ Chi-Square p = 0.826 Sample Size = 851 1

Table A-6: Ethnic Group by Age U U 12-13 14-15 16-17 Total 0 Maori Freq. 13 61 61 135 Row.% 9.63 45.19 45.19 Col.% 7.34 15.80 21.18

Non- Freq. 164 325 227 716 Maori Row.% 22.91 45.39 31.70 9 Col% 92.66 84.20 78.82

Total 177 386 288 851 0 [Chi-Square p = 0.000 Sample Size = 851 1 H ci U 5

Table A.7 Two additional ethnic groupings

Ethnic #2 WN %

Maori 138 15.5 611Pakeha 68.7 Others 108 12.1 Not known 33 3.7

Ethnic #3 lei

Maori 138 15.5

Pacific Islanders 37 4.2 Pakeha 611 68.7 Others 71 8.0 Not known 33 3.7 Table A.8: Ethnic group #2 by Area [1 Auckland Hawkes Bay Wgton Nelson Canty Not knwn Total U

Maori Freq. 28 71 8 9 18 1 135 Row.% 20.74 52.59 5.93 6.67 1333 0.74 [1 Col.% 12.90 27.73 12.50 9.47 9.84 2.78 U Pakeha Freq. 146 170 28 84 151 30 609 Row.% 23.97 27.91 4.60 13.79 24.79 4.93 Col.% 67.28 66.41 43.75 88.42 82.51 8333 C] Rest Freq. 43 15 28 2 14 5 107 Row.% 40.19 14.02 26.17 1.87 13.08 4.67 Col.% 19.82 5.86 43.75 2.11 7.65 13.89

Total 217 256 64 95 183 36 851

[Chi-Square p = 0.000 Sample Size = 851]

ci U U U ci U U U ci 7 Table A.9: Ethnic group #3 by Area

Auckland Hawkes Bay Wgton Nelson Canty Not knwn Total

Maori Freq. 28 71 8 9 18 1 135 Row.% 20.74 52.59 5.93 6.67 1333 0.74 Col.% 12.90 27.73 12.50 9.47 9.84 2.78

Pcfcl Freq. 23 1 10 0 3 0 37 Row.% 62.16 2.70 27.03 0.00 8.11 0.00 Col.% 10.60 0.39 15.63 0.00 1.64 0.00

Pakeha Freq. 146 170 28 84 151 30 609 Row.% 23.97 27.91 4.60 13.79 24.79 4.93 Col% 67.28 66.41 43.75 88.42 82.51 83.33

Rest Freq. 20 14 18 2 11 5 70 Row.% 28.57 20.00 25.71 2.86 15.71 7.14 Col.% 9.22 5.47 28.12 2.11 6.01 13.89

Total 217 256 64 95 183 36 851

[Chi-Square p = 0.000 Sample Size = 851 1

[I LJ C

Table A. 10 Ethnic Group #2 by Gender El El Female Male Total ci Maori Freq. 80 55 135 Row.% 59.26 40.74 Col.% 16.10 15.54

Pakeha Freq. 352 257 609 El Row.% 57.80 42.20 Col.% 70.82 72.60 ci

Other Freq. 65 42 107 Row.% 60.75 39.25 El Col.% 13.08 11.86 ci Total 497 354 851 ci

Chi-Square p=O.829 Sample Size = 851 1 [1 ci ci ci U U U U El / 9 Table All : Ethnic Group #3 by Gender

Female Male Total

Maori Freq. 80 55 135 Row.% 59.26 40.74 Col.% 16.10 15.54

Pcfcf Freq. 26 11 37 Row.% 70.27 29.73 Col.% 5.23 3.11

Pakeha Freq. 352 257 oz Row.% 57.80 42.20 Col.% 70.82 72.60

Other Freq. 39 31 70 Row.% 55.71 44.29 Col.% 7.85 8.76

Total 497 354 851

[Chi-Square p = 0.478 Sample Size = 851]

10 U U Table A.12: Ethnic Group #2 by Age El 12-13 14-15 16-17 Total 1 0

Maori Freq. 13 61 61 135 Row.% 9.63 45.19 45.19 CoL% 7.34 15.80 21.18 U Pakeha Freq. 145 280 184 609 Row% 23.81 45.98 30.21 Col.% 81.92 72.54 63.89

Other Freq. 19 45 43 107 Row% 17.76 42.06 40.19 Col.% 10.73 11.66 14.93

Total 177 386 288 851 El

{ Chi-Square p = 0.000 Sample Size = 851 J U El El El EJ U El El 11 Table A.13 : Ethnic Group #3 by Age

12-13 14-15 16-17 Total

Maori Freq. 13 61 61 135 Row% 9.63 45.19 45.19 Col% 7.34 15.80 21.18

Pacific Freq. 1 15 21 37 Islander Row.% 2.70 40.54 56.76 Col.% 0.56 3.89 7.29

Pakeha Freq. 145 280 184 MZ Row.% 23.81 45.98 30.21 Col.% 81.92 72.54 63.89

Other Freq. 18 30 22 70 Row.% 25.71 42.86 31.43 Col.% 10.17 7.77 7.64

Total 177 386 288 851

[Chi-Square p = 0.000 Sample Size 851]

IN C Tables relating to the additional ethnic groupings: U Table A-14: Smoking history by Ethnic group #2

Maori Pakeha Other

Never smoked 16 31 40 Tried smoking once 17 19 16 Smoked more than once 28 22 24 Smoked lots of times 39 29 19

[Chi-Square p = 0.001 ] ci Twice as many Maori have tried smoking than Pakeha, but less of the other ethnic minorities had tried smoking than pakeha. C More Maori smoke regularly than pakeha, and more pakeha smoke regularly than the other ethnic minorities combined.

Table A. 15 : Smoking history by Ethnic group #3

Maori Pacific I Pakeha Other

Never smoked 17 35 30 43 Tried smoking once 17 12 19 19 Smoked more than once 28 26 22 23 Smoked lots of times 39 26 29 16 U [Chi-Square p = 0.003 1 ci Pacific Islanders have a comparable rate of smoking to pakehas. U 0 ci U 13 Table A.16 : Current smoking status by Ethnic group #2

Maori Pakeha Rest

Non-smoker 56 66 80 Casual smoker 16 20 11 Regular smoker 28 14 8

[Chi-Square p = 0.000 ] Other ethnic minorities combined smoke less than both Maori and Pakeha.

Table A.17: Current smoking status by Ethnic group #3

Maori Pacific I Pakeha Other

Non-smoker 56 74 66 84 Casual smoker 16 15 20 9 Regular smoker 28 12 14 6

[Chi-Square p = 0.000] Pacific Islanders smoke almost as much as Pakeha.

Table A.18 : Cigarette Source by Ethnic group #2

Maori Pakeha Other

Buy them from a shop 64 48 33 (% of smokers) From friends 51 46 31 From mother or father 25 11 6 From brother or sister 24 9 12 Someone else buys them for me 17 15 10 From a slot machine 8 8 4

14 C Table A-19: Smoking history by Gender: Maori U

Female Male U

Never smoked 16 19 Tried smoking once 8 27 Smoked more than once 25 35 Smoked lots of times 52 19

[Chi-Square p = 0.001 Sample Size = 125]

Table A-20: Smoking history by Gender: Pakeha El

Female Male [I

Never smoked 30 31 [1 Tried smoking once 13 25 Smoked more than once 23 19 Smoked lots of times 33 25

{ Chi-Square p = 0.001 Sample Size = 590]

CI Table A.21: Smoking history by Gender: Other

Female Male II Never smoked 38 47 Tried smoking once 17 11 Smoked more than once 22 29 C Smoked lots of times 22 13 0 [Chi-Square p = 0.436 Sample Size = 101] ci

ci 15

Table A.22: Smoking history by Age : Maori

12-13 14-15 16-17

Never smoked 36 16 14 Tried smoking once 9 5 26 Smoked more than once 18 27 33 Smoked lots of times 36 52 28

{ Chi-Square not valid Sample Size = 125]

Table A.23 : Smoking history by Age Pakeha

12-13 14-15 16-17

Never smoked 42 30 23 Tried smoking once 19 17 20 Smoked more than once 20 22 22 Smoked lots of times 18 32 35

[Chi-Square p = 0.003 Sample Size = 5901

Table A.24: Smoking history by Age Other

12-13 14-15 16-17

Never smoked 47 49 31 Tried smoking once 5 16 18 Smoked more than once 21 21 31 Smoked lots of times 26 14 21

[Chi-Square not valid Sample Size = 101]

16 Ci Table A.25 Smoking history by Ethnic group: Females El]

Maori Pakeha Others 11

Never smoked 16 30 38 Tried smoking once 8 13 17 Smoked more than once 25 23 22 Smoked lots of times 52 33 22

[Chi-Square p = 0.004 Sample Size = 482] 0

Table A.26: Smoking history by Ethnic group : Males [J

Maori Pakeha Others LIII

Never smoked 19 31 47 ElI Tried smoking once 27 25 11 Smoked more than once 35 19 29 Smoked lots of times 19 25 13

[Chi-Square p = 0.011 Sample Size = 334]

U Table A.27: Smoking history by Ethnic group: Age 12-13

Maori Pakeha Other El Never smoked 36 42 47 Tried smoking once 9 19 5 Smoked more than once 18 20 21 Smoked lots of times 36 18 26 El [Chi-Square not valid Sample Size = 169] Ci

U 17 Ci Table A.28: Smoking history by Ethnic group: Age 14-15

Maori Pakeha Other

Never smoked 16 30 49 Tried smoking once 5 17 16 Smoked more than once 27 22 21 Smoked lots of times 52 32 14

[Chi-Square p = 0.000 Sample Size = 369]

Table A.29 : Smoking history by Ethnic group: Age 16-17

Maori Pakeha Other

Never smoked 14 23 31 Tried smoking once 26 20 18 Smoked more than once 33 22 31 Smoked lots of times 28 35 21

[Chi-Square p 0.164 Sample Size = 278]

Table A.30: Current smoking status by Age: Maori

12-13 14-15 16-17

Non-smoker 64 45 66 Casual smoker 9 20 14 Regular smoker 27 36 21

[Chi-Square not valid Sample Size = 125]

Table A.31 : Current smoking status by Age: Pakeha

12-13 14-15 16-17

Non-smoker 78 64 61 Casual smoker 16 23 18 Regular smoker 6 13 20

[Chi-Square p = 0.001 Sample Size = 590]

Table A.32: Current smoking status by Age: Other

12-13 14-15 16-17

Non-smoker 79 81 79 Casual smoker 11 19 5 Regular smoker 11 0 15

[Chi-Square not valid Sample Size = 101]

Table A.33 : Current smoking status by Gender: Maori

Female Male

Non-smoker 45 73 Casual smoker 16 17 Regular smoker 39 10

[Chi-Square p = 0.002 Sample Size = 125]

19 Table A.34 : Current smoking status by Gender: Pakeha

Female Male

Non-smoker 63 72 Casual smoker 22 17 Regular smoker 15 11

[Chi-Square p = 0.057 Sample Size = 590]

Table A.35 : Current smoking status by Gender: Other

Female Male

Non-smoker 76 87 Casual smoker 16 5 Regular smoker 8 8

[Chi-Square p 0.057 Sample Size = 590]

Table A.36 : Current smoking status by Ethnic group: Females

Maori Pakeha Others

Non-smoker 45 63 76 Casual smoker 16 22 16 Regular smoker 39 15 8

[Chi-Square p = 0.000 Sample Size 482]

20 ci Table A.37: Current smoking status by Ethnic group : Males U Maori Pakeha Others U Non-smoker 73 72 87 Casual smoker 17 17 5 Regular smoker 10 11 8 [I [Chi-Square p = 0.383 Sample Size = 334] ci Table A.38 : Current smoking status by Ethnic group : Age 12-13

Maori Pakeha Others

Non-smoker 64 78 79 Casual smoker 9 16 11 Regular smoker 27 6 11 ci [Chi-Square not valid Sample Size = 169]

Table A.39 : Current smoking status by Ethnic group : Age 14-15

Maori Pakeha Others

Non-smoker 45 64 81 Casual smoker 20 .23 19 Regular smoker 36 13 0

ci [Chi-Square p = 0.000 Sample Size = 369]

ci U U 21 Table A.40: Current smoking status by Ethnic group : Age 16-17

Maori Pakeha Others

Non-smoker 66 61 79 Casual smoker 14 18 5 Regular smoker 21 20 15

[Chi-Square p = 0.216 Sample Size = 278]

Table A-41: Smoking history by Area

Wellington Other areas excluding Hawkes Bay

Never smoked 33 30 Tried smoking once 19 21 Smoked more than once 16 23 Smoked lots of times 33 26

[Chi-Square p = 0.420 Sample Size = 570]

Table A.42: Smoking history by Area for those who have tried smoking once

Wellington Other areas excluding Hawkes Bay

Tried smoking once 28 30 Smoked more than once 23 33 Smoked lots of times 49 37

[Chi-Square p = 0.257 Sample Size = 396 ]

22 U

Table A.43 Smoking history by Area U U Wellington Other areas excluding Hawkes Bay

Non-smoker 70 70 Casual smoker 22 18 Regular smoker 8 12 [Chi Square p = 0.453 Sample Size = 560 ] U These figures show that there is no statistically significant difference in smoking behaviour between the Wellington sample and the other areas. Table A.44 Smoking history by Area (1

Nelson Other areas excluding Hawkes Bay LI

Never smoked 33 30 LI Tried smoking once 20 21 Smoked more than once 16 24 Smoked lots of times 30 26 U [Chi-Square p = 0.378 Sample Size = 570]

Table A.45: Smoking history by Area for those who have tried smoking U Tried smoking once 30 29 Smoked more than once 24 34 Smoked lots of times 45 37 U [Chi-Square p = 0.255 Sample Size = 396 1

U U 23 Table A-46: Current smoking status by Area

Nelson Other areas excluding Hawkes Bay

Non-smoker 67 71 Casual smoker 19 18 Regular smoker 15 11

[Chi-Square p = 0.605 Sample Size = 560] These figures show that there is no statistically significant difference in smoking behaviour between the Nelson sample and the other areas.

24 0 U 9 Ii P] Ii Ii II p

Lo ro

w p p Appendix 3

Retailer information and support needs survey Health Research & Department Analytical Services P.O. Box 1876 of Health Christchurch TETARI ORA Tel. (03)377-1797 Fax (03)377-1587 February 16, 1993 DEAR RETAILER

Survey of retailers views on their support and information needs related to the Smoke-free legislation.

The Department of Health administers the Smoke-free Environments Act (1990). One of the aims of Part U of this legislation is to regulate tobacco advertising in shops and the media.

The Department of Health wants to find out what additional information and support retailers would like to receive from the Department of Health regarding the requirements of the Smoke-free legislation. The results of this survey will be used for future planhing on how best to meet the information and support needs of retailers.

The attached survey is being sent to dairies, groceries and supermarkets listed in the yellow pages of the telephone book. This is an anonymous survey and individual responses will remain anonymous.

It is important that retailers are consulted and given the opportunity to express their opinions. I hope you will give this important survey your support.

After completing the survey please post it back as soon as possible. A reply paid envelope is attached for your use.

If you have any questions about any aspects of this survey please contact:

Dr Ray Kirk Health Research and Analytical Services P. 0. Box 1876 Christchurch

Yours sincerely

Dr R. Kirk

Health for all by the year 2000 Retailer Survey - Smoke-free legislation

1. Have you received any information about the Smoke-free legislation? Please circle your response. Yes No Dont Know

If Yes, where did you receive this information from? Please tick information sources.

Department of Health Area Health Board Retailers Association Mixed Business Association Tobacco Institute Tobacco Company Newspaper, magazine. Family, friends Other, please specify______

What was this information about?

2. Do you understand the requirements of the Smoke-free legislation for retailers of tobacco products? Please circle your response.

Yes No Dont Know

3. Do you think all your other staff understand the requirements of the Smoke- free legislation for retailers of tobacco products? Please circle your response.

Yes No Dont Know

4. Do you want more information on the requirements of the Smoke-free legislation? Please circle your response.

Yes No Dont Know

If yes, what is your preferred method of obtaining more information on the requirements of the Smoke-free legislation? Please tick your preferred method.

[ J written material, pamphlet. [ I national free-phone for information. [ ] personal contact and explanation. [ I another way, please specify______

1 5. Have you received support and assistance from any of the following organisations promoting the Smoke-free legislation?

Yes No Dont Know

Department of Health .... Area Health Board .... Retailers Association ...... Mixed Business Association .... Tobacco Institute .... Tobacco Companies ...... Other, ....

6. Did you receive from the Department of Health or any other organisation a sticker indicating that you cannot sell cigarettes or tobacco to persons under 16 years? El Yes No Dont Know

7. Is it difficult for you to tell if a customer is under 16 years of age?

Yes No Dont Know

If yes, what do you think would make this easier? For example, would raising the age restriction from 16 to 18 years of age be easier for you? fl U El

8. Do you think retailers sell cigarettes to children under 16 years of age who have notes from parents or who have parents in a vehicle outside the shop?

Yes No Dont Know

9. What support and assistance would you like the Department of Health to provide for you?

U El U IJ 2 10. What information would you like the Department of Health to provide for you?

Following is a list of statements related to the Smoke-free legislation. Please indicate if you agree, disagree or dont know if these statements reflect the intention of the Smoke-free legislation. Please circle your response.

11. No new tobacco product advertisements may be put up in or outside shops.

Agree Disagree Dont Know

12. Existing tobacco product advertising signs erected before 16 December 1991 and which include health warnings can stay up until 1 January 1995, but may not be altered or repaired.

Agree Disagree Dont Know

13. Tobacco product advertising signs without a health warning must be removed.

Agree Disagree Dont Know

14. All tobacco product advertising signs must be removed after 1 January 1995.

Agree Disagree Dont Know

15. Tobacco products may be displayed in your shop, as long as they cannot be seen from outside your shop.

Agree Disagree Dont Know

16. Tobacco product price displays inside your shop must not exceed 297 mm x 630 mm (3 x A4 sheets).

Agree Disagree Dont Know

3 17. Notices inside your shop can only show what tobacco products you have for sale and how much they cost.

Agree Disagree Dont Know

18. The shop name cannot include the trademark of the company name of a tobacco product. Agree Disagree Dont Know

19. A shop can indicate it sells tobacco e.g., "Seymours Tobacconist", but the name cannot be displayed more than twice without a health message.

Agree Disagree Dont Know

20. A retailer can not sell cigarettes or tobacco products to persons under the age of 16 years. Agree Disagree Dont Know

21. A retailer should display a sign in their shop that the sale of any tobacco product to persons under 16 years is prohibited.

Agree Disagree Dont Know

22. Were you aware that retailers who put up new tobacco advertisement can be fined up to $10,000, if convicted?

Yes No Dont Know

23. Were you aware that retailers who sell tobacco products to people under 16 years can be fined up to $2000, if convicted?

Yes No Dont Know

24. Do you display shop signs or posters indicating or suggesting sponsorship of sporting or non-sporting events by a tobacco product manufacturer or company?

Yes No Dont Know

25. How long have you been a retailer at this address?

[ ] Less than 1 year [ J Between 1 and 2 years Between 2 and 5years [ ] Over 5 years

PLEASE TURN OVER ci 4 £3 26. How do you sell cigarettes? Please tick all that apply

Singly Packets of 10 Packets of 14 Packets of 15 Packets of 20 Packets of 25 Packets of 30 Cartons Other, please specify

27. Do you have any further comments concerning the sale and advertising of tobacco products related to the Smokefree legislation?

Thank you very much for your help and assistance in completing the survey. Please post it back in the reply paid envelope.

5 Appendix 4

The Retailer Survey Crosstabulation Tables 1J

Section I: Retailer replies to the survey broken down by question number and type of retailer, either dairy or grocery, supermarket, as printed in the yellow pages of telecom phone books. 9 Have you received any information about the Smoke-free legislation? 9 Dairy Grocery, Supermarket 9 Yes 57.7 66.1 No 37.1 27.7 D/K 5.2 6.2 9 N 537 448 9 chi square = 9.776, p = 0.008

ci Do you think all your other staff understand the requirements of the Smoke-free legislation for retailers of tobacco products? 9 Dairy Grocery, Supermarket [1 Yes 60.2 55.9 No 24.9 32.6 9 D/K 14.9 11.5 9 N 523 433 9 chi square = 7.735, p = 0.021 ci ci 0 ci

1 ci Have you received support and assistance from the [Retailers Association] promoting the Smoke-free legislation?

Dairy Grocery, Supermarket

Yes 9.7 39.7

No 82.5 53.4 D/K 7.8 6.9

N 382 350 chi square = 91.19, p = 0.001

Have you received support and assistance from any [other] organisations promoting the Smoke-free legislation?

Dairy Grocery, Supermarket Yes 1.5 9.4 No 85.8 76.0 D/K 12.7 14.6

N 260 171 chi square = 15.069, p = 0.001 9

Is it difficult for you to tell if a customer is under 16 years of age? 9

Dairy Grocery, Supermarket

Yes 80.5 74.9 9 No 19.5 25.1 9 N 524 442 9 chi square = 4.449, p = 0.035

Following [questions 11 to 24] is a list of statements related to the Smoke-free legislation. Please indicate if you [retailer] agree, disagree or dont know if these statements reflect the intention of the Smoke-free legislation. 11

11. No new tobacco product advertisements may be put up in or outside shops. LI Dairy Grocery, Supermarket

Agree 46.8 60.6 Disagree 42.3 30.4 D/K 10.8 9.0 9

N 536 444

U chi square = 18.84, p = 0.000 ID

£3

3 LI 14. All tobacco product advertising signs must be removed after 1 January 1995.

Dairy Grocery, Supermarket

Agree 40.8 50.0 Disagree 44.3 35.1 D/K 14.9 14.9

N 537 444 chi square = 9.700, p = 0.008

20. A retailer can not sell cigarettes or tobacco products to persons under the age of 16 years.

Dairy Grocery, Supermarket

Agree 84.8 92.0 Disagree 12.8 6.6 D/K 2.4 1.4.

N 533 440 chi square = 12.058, p = 0.002

4 IJ

24. Do you display shop signs or posters indicating or suggesting sponsorship of sporting or non-sporting events by a tobacco product manufacturer or U company?

Dairy Grocery, Supermarket [] Yes 17.8 12.1 No 76.6 84.7 El D/K 5.6 3.2 U N 534 432 chi square = 10.206, p = 0.006 El

26. How do you sell cigarettes? [singly, packets of 10, 14, 15, 20, 25, 30, cartons, other]. U

Dairy Grocery, Supermarket

1-5 39.5 26.2 products

6 products 23.9 20.9 7+ products 36.6 52.9 U N 552 465 chi square = 29.55, p = 0.000 El El El U El

Section II: Retailer replies to the survey broken down by question number and length of time, in years, respondent has been a retailer at the present address.

Have you received any information about the Smoke-free legislation?

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Yes 24.6 56.9 63.4 82.3 No 68.9 37.2 9.4 13.8 D/K 6.6 5.8 7.2 3.9

N 167 188 292 305

chi square = 164.234, p = 0.000

Have you received any information about the Smoke-free legislation? If YES, where did you receive this information from? [Department of Health, Mixed Business Association, Area Health Board, Tobacco Institute, Tobacco Company, Retailers Association, Family, friends, Newspaper, magazine]

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

1 source 89.4 81.2 66.9 56.9

2 sources 6.5 12.2 16.5 22.5

3+ sources 4.1 16.6 20.6

N 169 197 296 320

chi square = 72.058, p = 0.000

Have you received any information about the Smoke-free legislation? If YES, what was this information about? [Smoke-free workplace policy; Sale of 9 cigarettes to under 16 year olds; Health message on tobacco advertising signs; Display of tobacco products in shops; Display Notices about tobacco products; Display Notices about tobacco company sponsored sports events; Information about the use of tobacco vending machines; The use of tobacco products as gifts; other] [1 Length of time (in years) the retailer has been at present address <1 1-2 2-5 >5

1-2 issues 88.2 70.6 56.1 47.8 3-4 issues 4.7 18.8 19.9 27.2

5+ issues 7.1 10.7 24.0 25.0

N 169 197 296 320 II

chi square = 92.018, p = 0.000 II

Do you understand the law regarding the advertising and sale of cigarettes and tobacco products? II Length of time (in years) the retailer has been at present address 9 <1 1-2 2-5 >5

Yes 35.3 44.0 50.4 54.7 some of 54.5 49.2 45.8 43.0 it II

D/K 10.2 6.7 3.8 2.3 II

N 167 193 288 309 A

chi square = 28.25 1, p = 0.000 El II 7 ci

Do you want more information on the requirements of the Smoke-free legislation from the Department of Health?

Length of time (in years) the retailer has been at present address <1 1-2 2-5 >5

Yes 75.4 62.0 58.5 50.0 No 19.8 33.7 36.9 47.1 D/K 4.8 4.3 4.5 2.9

N 167 187 287 312

chi square 36.404, p = 0.000

Have you received support and assistance from the [Department of Health] promoting the Smoke-free legislation?

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Yes 14.4 26.5 34.2 48.4 No 77.8 64.5 55.7 46.3

D/K 7.8 9.0 10.1 5.3

N 153 166 237 244

chi square = 56.462, p 0.000

8 U Have you received support and assistance from the [Area Health Board] promoting the Smoke-free legislation? U

ci Length of time (in years) the retailer has been at present address 9 <1 1-2 2-5 >5

Yes 3.6 8.6 12.4 28.5 No 87.2 80.8 74.3 62.7 D/K 9.2 10.6 13.3 8.8 ci N 141 151 210 193

chi square = 52.427, p = 0.000 El

Have you received support and assistance from the [Retailers Association] promoting the Smoke-free legislation? U Length of time (in years) the retailer has been at present address 9 <1 1-2 2-5 >5 U Yes 4.9 9.5 22.6 47.9 No 86.7 81.1 69.8 46.5 ElI D/K 8.4 9.5 7.6 5.6 9 N 143 148 212 213

chi square 113.341 p = 0.000 U U U 9 9

Have you received support and assistance from the [Mixed Business Association] promoting the Smoke-free legislation?

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Yes 0.7 2.0 8.1 19.4

No 91.3 88.4 81.3 73.3

D/K 8.0 9.6 10.6 7.3

N 138 146 198 165

chi square = 47.076, p = 0.000

Have you received support and assistance from the [Tobacco Institute] promoting the Smoke-free legislation?

Length of time (in years) the retailer has been at present address <1 1-2 2-5 >5

Yes 0.8 2.1 7.2 10.7 No 91.2 87.2 81.3 77.4 D/K 8.0 10.6 11.4 11.9

N 137 141 193 159

chi square = 20.545, p = 0.002

Have you received support and assistance from the [Tobacco Companies] promoting the Smoke-free legislation?

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Yes 12.7 30.1 38.3 46.0 No 78.2 61.5 53.2 47.0

D/K 9.1 8.3 8.5 7.0

N 142 156 235 200

chi square = 45.584 p = 0.000

Have you received support and assistance from [other] organisations promoting the Smoke-free legislation?

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Yes 1.8 4.3 3.2 10.3 No 88.9 81.9 81.7 73.2 D/K 9.3 13.8 15.1 16.5

N 108 94 126 97 U El chi square = 12.845, = 0.046 p U U El 11 0

Did you receive from the Department of Health or any other organisation a sticker indicating that you cannot sell cigarettes or tobacco to persons under 16 years?

Length of time (in years) the retailer has been at present address <1 1-2 2-5 >5

Yes 67.3 81.6 91.2 96.5 No 28.0 16.3 7.4 2.5 D/K 4.7 2.1 1.4 1.0

N 168 196 296 318

chi square = 93.497, p = 0.000

Do you think retailers sell cigarettes to children under 16 years of age who have notes from parents or who have parents in a vehicle outside the shop?

Length of time (in years) the retailer has been at present address <1 1-2 2-5 >5

Yes 55.5 60.7 56.3 46.7 No 23.2 18.3 17.7 29.9 D/K 21.3 20.9 26.0 23.4

N 164 191 288 304

chi square = 18.382, p = 0.005

12 Following [questions 11 to 24] is a list of statements related to the Smoke-free legislation. Please indicate if you [retailer] agree, disagree or dont know if these statements reflect the intention of the Smoke-free legislation.

11. No new tobacco product advertisements may be put up in or outside shops.

Length of time (in years) the retailer has been at present address <1 1-2 2-5 >5

Agree 44.8 53.3 51.5 59.3 Disagree 40.0 35.4 38.9 33.6 D/K 15.2 11.3 9.6 7.1

N 165 195 293 312 chi square = 13.678, p = 0.033

U ci ci 13 ci

12. Existing tobacco product advertising signs erected before 16 December 1991 and which include health warnings can stay up until 1 January 1995, but may not be altered or repaired.

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Agree 56.1 54.9 57.5 62.7 Disagree 27.4 29.7 36.0 29.9

D/K 16.5 15.4 6.5 7.3

N 164 195 292 314

chi square = 22.546, p = 0.001

13. Tobacco product advertising signs without a health warning must be removed.

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Agree 79.5 10.9 78.2 77.4 Disagree 12.7 15.3 16.3 15.7

D/K 7.8 13.8 5.4 6.9

N 166 196 294 318

chi square = 13.172, p = 0.040

14 14. All tobacco product advertising signs must be removed after 1 January 1995.

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Agree 43.0 42.1 44.2 48.7

Disagree 36.4 37.4 44.2 40.5 D/K 20.6 20.5 11.6 10.8

N 1 165 195 294 314 chi square = 17.273, p = 0.008

U U U U U 15 U 15. Tobacco products may be displayed in your shop, as long as they cannot be seen from outside your shop.

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Agree 35.3 49.0 50.7 48.2 Disagree 49.7 35.2 40.1 43.8 D/K 15.0 15.8 9.2 7.9

N 167 196 294 315 chi square = 20.453, p = 0.002

17. Notices inside your shop can only show what tobacco products you have for sale and how much they cost.

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Agree 71.7 633 72.1 66.9 Disagree 15.7 22.4 19.9 25.5 D/K 12.6 14.3 8.0 7.6

N 166 196 287 314 \ chi square = 14.749,, p = 0.022

IV-

22. Were you aware that retailers who put up new tobacco advertisement can be fined up to $10,000, if convicted? fl

Length of time (in years) the retailer has been at Present address

N U Yes 20.8 39.1 43.8 42.8 No 69.6 53.3 50.7 49.4 11 D/K 9.5 7.6 5.5 7.9

N 168 197 292 318 U chi square = 29.336, p = 0.000 U

23. Were you aware that retailers who sell tobacco products to people under 16 years can be fined up to $2000, if convicted?

Length of time (in years) the retailer has been at present address 11 <1 1-2 2-5 >5

Yes 60.5 72.6 82.4 83.3 No 32.3 23.9 14.9 15.1 U D/K 7.2 3.5 2.7 1.6 U N 167 197 295 317 U chi square 42.010,= p 0.000 El H El 17 9

24. Do you display shop signs or posters indicating or suggesting sponsorship of sporting or non-sporting events by a tobacco product manufacturer or company?

Length of time (in years) the retailer has been at present address

<1 1-2 2-5 >5

Yes 8.9 14.2 18.6 16.2 No 85.7 80.2 75.5 81.8 D/K 5.4 5.6 5.9 1.9

N 168 197 290 314

chi square = 15.474, p = 0.019

18 Appendix 5

Retailer Comments about the Smokefree Legislation Further comments by grocery and supermarket retailers about the Smokefree legislation are as follows:

With the amount of non paid activity carried out by businesses today on behalf of Government and Government agencies it hardly gives a business person time to run his own buisiness effectively. All you can morally ask a business to do is do their best. A copy of the Smoke Free legislation should be made available to retailers in laymans language. Prohibition of alcohol did not work. Advertising in my view should not be banned by 1995 if people want to smoke they will do it no matter what advertising, also is a means of adding a different atmosphere to the environment in which you are advertising. Cigarettes should not be sold singly as they cannot display a health warning. Re sec. 15 - it is better if cigarettes etc can be seen clearly from the street. If put out of sight it makes it too easy for burglary to remove goods in private, if seen from the street it is a deterrent & they can be caught more easily - think about it Increase the tax & pay to hospitals. Cut down on Health Dept expenditure other than medical care. We do not encourage the purchase of tobacco products - we only stock small range to satisfy customer demand. If the demand wasnt there we wouldnt be selling I think the company making cigarettes should be responsible for helping anyone who wants to give up. Why should the people of NZ kill themselves slowly for profit. I suggest the counter pack system be banned as a method to circumvent current legislation. Children in school uniforms are very hard to "age" - many are actually over 16.That is making it very difficult. Why not have a statutory declaration of age document as used in relation to the sale of liquor when the age of the purchaser is in doubt/dispute SELLING MORE TOBACCO 30G AND 50G THAN USUAL. Unfortunately particularly for young Maori people particularly girls, it is not stopping them smoking. How you get through to them I do not know. 1.Sale & advertising of tobacco products should be outlawed. 2. Selling Cigarettes in shops, supermarkets, foodbar, restaurants or any other suppliers should be banned & outlawed. 3. Cigarette manufacturers can open their own shop & sell cigarettes. Nobody, absolutely nobody should sell cigarettes.... If people wish to smoke then let them. Why should sport be penalised frgm sponsorship. Advertising of tobacco products should not be discontinued. People will always smoke anytime they want to, however I am against young people smoking under 12 yrs. old, not 16 yr. olds. Ban as soon as possible so I dont have to put up with burglars stealing them. People moaning about credit for them & the bloody horrible smoke in the shop. Please. We feel that we should be able to advertise products for sale within our store - be it cigarettes or whatever. Advertising to educate public about the legislation, eg: TV, newspaper, radio, magazines etc. I have got enough to do without promoting the above- I dont smoke not particularly bothered about selling, but have to as people will not shop in my store. Keep up the good work. I agree that discouraging smoking is a good aim. Legislation to date is not working. Young teenage smoking population growing. Restrictions on cigarettes sales will not cure the problem particularly teenagers will be more likely to smoke. Go for it! No, the whole exercise is overdone at retail level, but public education about the dangers of smoking and passive smoking should continue. There are far too many regulations concerning the sale and advertising. I feel that reduction of advertising in due course would suffice. Prosecution of retailers is wrong unless they knowing sell to somebody under 16. It is correct but one has to wear two hats, business is there for profit and tax, moderation is required, some people smoke all their lives & live to a ripe old age. Others suffer earlier, if one has to pay for health service the decision is theirs..... This is a load of bullshit. What happened to the freedom of the individual? People have the right to make their own decisions. Keep out of other peoples business. I think peoples private decisions are being hampered by the dropping of advertising & sports are being severely limited due to the lack of funding allowed by cigarette companies. Cigarettes may do harm but the money for sponsorship did a lot of good. I disagree totally with the ban on sporting sponsorship and I think this will be very detrimental to sporting codes. I dont believe cigarette companies get people smoking by having their names attached to sports events. Far to restrictive, legislation gone crazy. Why not repair signs? that are damaged. How can shops display products that are not allowed to be seen from the outside, that is why shopkeepers wish to display products so that they can be seen. Hit all of this on the head, no more. All our preschool-primary & secondary school grounds should be made to have compulsory smoke free areas on whole campus - also sports grounds for young or any healthy lifestyle programs setup for our children. Public need educating that shops are smoke free areas! Constant battle "please put the cigarette Out. This is a smoke free area!" I feel that it is impossible to comply with your rule that cigarettes should not be seen from the street when most shop frontages are open and cigarettes are kept at the check-out for security reasons. I believe that tobacco sponsorship is important to have but it needs to be strictly governed. Advertising should not show younger people. Most importantly people should be given a choice of what they want thats why we live in NZ. I would like all advertising inside and outside all shops removed as soon as possible. Smokes are high on the nick list and therefore need to be on the check-out. Yet according to what I have been told they must not be visible from the Street if this is correct it makes supervision difficult. We support the thrust of the legislation on a personal level but we of course make considerable profits from the sale of such products. I disagree with the legislation & feel that the Government have made the self employed unpaid workers for the tax dept and are now making us unpaid worker for the police. Why is it an offence to sell to someone you think to be 16 but you are wrong. But it is not.... Having been in retail for the past 20 yrs. I dont believe advertising has made a huge difference in sales. I do believe a lot of peer pressure etc is put on our youth to smoke & believe that by early child education on the dangers of smoking is the best Only this - whatever you do for smoke free you should also do for alcohol especially advertising. A bit of tolerance for long term smokers wouldnt go amiss. There seems to be more & more laws being made that a tolerance would render unnecessary. In my view laws should be a guide not an end in themselves. Should make the sale and advertising as strict as possible. LA sign should also be displayed by retailer indicating that it is offence for any person under 16 to buy cigarettes and 2. Management reserves right to refuse sale of tobacco/cigarette to any person. Dairy should be allowed to sell tobacco. Yes restrict smoking to 16 yr.. olds but educate kids at school as to the risk. The best way to stop smoking is to price. We should be allowed to sell to kids with a note if signed by a parent. A dairy owner knows... A lot of what Ive been told about smoke free legislation, if correct, is bureaucratically oppressive and not practically throughout. How do you send information to me if I dont put my name down? Please let tobacco companies sponsor sport etc if they want to. It must be possible to advertise & not be balant about it. I dont want my tax money to support "smoke free". 1.Lack of education at home & at school. 2. Irresponsible parent should be fined not shopkeeper. Seems very silly to me that a store/dairy or garage cannot put on their supply board outside the store/garage the word cigarettes along with the other things they may sell. After all they are not illegal. Cigarettes, papers, pies, condoms, bread, pet food etc. Yes. I think the bans you are putting on smoking stinks more than the smoke when you allow booze to be advertised over TV like you do. It is double standards. Smoking should be illegal in all public places except private properties. Yes, you should have the same kind of law for alcohol as this is a more serious health and social disease than tobacco, more people are harmfully affected by booze than smokes. If the Government wants people to stop smoking they must ban all sales of tobacco and related products. As long as tobacco is a legal product we should be able to advertise and sell this product. I think the advertising of tobacco products outside retail premises should be stopped & inside sales material for advertising for sale should also be stopped. I believe it is very unfair that a retailer can be fined for selling cigarettes to a person under the age of 16, yet the purchasers are allowed to walk away without any conviction. Tobacco products should be phased out gradually. We have banned smoking in our supermarket and staff areas and staff have supported this move. In this day if we stock anything, tobacco or otherwise, we wish to maximise sales. We stock many thinks that we dont like but it is what the customer wants and we want as much of their money as possible. It is their choice what they do with their money. We ensure all cigarettes and tobacco are in locked carasels at all times. Only staff can obtain packets from these. Either ban cigarette smoking or permit free advertising as with any other product. I do not know very much about the legislation however I feel there is a two faced attitude in place here. There are a great many things that are health dangers, drinking, overeating, eating wrong foods, stress, unemployed (being), redundancy. Drinking... It is a parents responsibility to deter their children from smoking - not retailers or Government No smoking zones have got out of hand. Discrimination against adults smokers is abysmal. The Government should be banned from being so Hitlerish re smokers. The whole thing is a pain! Question - how much is this stupid survey costing? Large fines for this type of offence is absolutely counter productive & seen as money grabbing by the Government. Fines should be relative to the offence, ie manslaughter involving car accident (doesnt make sense!!). Persuasion and info is better by far. We have a lot of people coming into our shop smoking. We have prominent signs prohibiting smoking. We have also lost customers by telling people they cannot smoke in the shop. What would you do? Parents of children under 16 should be prosecuted as well as the retailer for purchasing cigarettes. Its continuing regardless of our opinion. I see soccer is till being sponsored by tobacco in spite of high falutin Government statements. Does this not seem hypercritical? I think the law as I understand it is a waste of time when most people dont see no smoking signs. Peoples habits have to change not laws put in place to make them change. I cant understand why my customers have to be faced with no smoking signs. Ban all sales or allow free market. I feel that in this day and age there are a lot of worse things happening than people smoking. Maybe you can stop others from starting but to do that you will have to ban them completely & that is totally impossible. If people are going to smoke they

I think it should be up to the individual shop owner what to advertise or not advertise in their own shops. It should be up to the shop owner whether or not he/she allows smoking in their shops as the public usually make up their own minds where they want to smoke. As a shop owner it is part of our business and income. Advertising in and around the shop should not be restricted. Please keep us in touch with the rules concerning sale & advertising of tobacco products. Very very few under 16s ever did buy cigarettes in my shop before legislation anyhow - most of them disagreed with their parents smoking and were vocal about it. We do not sell cigarettes. We support efforts to remove tobacco smoking from our environment. Further to 13 and 14. My store has become quite famous for its old metal signs. One relating to tobacco is a large sign depicting a packet of cigarettes & proclaiming "Greys are Great". Because of the extreme interest in this sign I am reluctant to have it removed. I believe cigarette advertising/sponsorship is quite acceptable while cigarette smoking is legal, but this advertising/sponsorship should be restricted to aim at EXISTING smokers as a means of brand switching. So very often customers neglect "no smoking" notice in the shop and enter puffing cigarettes. When reminded politely they get offended, abusive & above all stop buying. ? steps should if any should be taken in such circumstances. You may think from some of my answers that I am a smoker. Believe me that is far from the truth; I am 54 yrs. old male and have never tried a cigarette in my life. But I also like living in a non police state. We have too much legislation. Under 16 yes,... Whole heartedly support the legislation. Have never had anything to do with tobacco advertising and never will. Only to add that I would like to see a compulsory price rather than a suggested price and that would include small shops as well as large supermarkets so the younger generation are not going around shop to shop looking for cheaper cigarettes. Some chain stores are retailing tobacco products at discount prices. I feel that no attractant relating to the sale of these products should be used. The product must always be available to those who require them. Need more advertising and education - on-going. When law was first introduced was a lot of money spent on advertising and education has seemed to fizzle. The no smoking in public places ie inside shops should be widely publicised to avoid us the embarrassment of policing this aspect. To much onus being placed on shopkeepers and staff. We are not policemen or judge or juror. As a new retailer and an anti-smoker myself Ive found since Ive been selling cigarettes that they are a very important part of peoples lives and if we have not got the products customers ask for they get very anti your shop. Its a very important.... There is public ie customer, ignorance re 1. 16 yr. rule 2. adults sending in kids to buy cigarettes 3. smoking in food shops. It would be handy for retailers to have a supply of leaflets explaining these rules to hand to problem customers. Stopping tobacco advertising will not stop under 16 yr. old smoking. Its got to the stage of ridiculous overkill re Q22. A person can commit GBH and get away with a minor conviction compared to these fines. When a shop changes hands the Dept. should make sure the new owners have all the appropriate literature and is conversant with the regulations. I have received nothing apart from what I already knew about. If I had a choice and could make a living without selling cigarettes I would. Educate the very young about the dangers of smoking to their health. We are in the business of selling products to our customers. They need to be advised of new brands of any products freely such as in displays or advertising whether it be a new cigarette or a new ice-block. We endeavour to only sell to over 16s but quite.. Since the advent of this restriction we have been abused by adults because we would not sell to their children. We have been abused by young people because they have not been able to provide proof of age. We have lost some very good, regular customers Ban all advertising/signage/display material - allow only sponsorship. The power of the antismoking lobby has grown to ridiculous proportions in recent years. Much of their propaganda is alarmist rubbish. I am a non smoker myself but believe those who wish to smoke should be left alone. I believe you have to target the schools. Your detriment ads have to be a lot more hard hitting, they have about as much impact as a wet newspaper. In your ads no mention is made of the cost of smoking ie how much you could save if you did not smoke. Not really. While I personally detest smoking the sale of cigarettes is a large part of my business and may make the difference between profit and loss. Do not sell cigarettes or tobacco. I would like to see that all public areas, workplaces eg staff cafeteria, and all foodstores become strictly non smoking areas with the help of publicity and on- going advertising. Advertisements should be made to be more dramatic & discourage potential... No comment apart from it seems to be a very involved legislation. More TV campaigns as if it is on TV and if shopkeeper hasnt got it, you have missed the boat. Feel strongly this will work more than any signs etc as after one month people especially children 15 yrs. old dont take any notice of signs that dont standout Tobacco companies should be allowed to sponsor should they wish to. People today arent going to smoke because of advertising. All smoking should be banned. I have watched too many people die of smoke related diseases - this includes mother and father and father-in-law. I think we do have the odd person trying to beat the system and get cigarettes even when under age. This makes our job difficult. I believe we need more signs to deter people that are under age also to tell them the dangers of smoking. Just like a stop sign... I disagree with current legislation to ban advertising & sponsorship by tobacco companies. I feel there are more needy problems to witch hunt without taking peoples choices and much needed sponsorship from sportsmen. Regards. I totally agree that existing smokers be made fully away of the hazards of cigarette smoking and young people be dissuaded strenuously from even trying it out but am afraid that total withdrawal of tobacco from shops will put it back with the days of bootleg.. Free country, free people. It is a very clear area if you remove from it the fiscal implications of the drastically reduced Government income should smoking be banned or severely curtailed. It is not a Health Dept area. It is without doubt a FISCAL PROBLEM. Resolve this and the stopping.. If we leave things as they are we will be fine. If we try & change society and/or the well being of society, you will cause no end of trouble. Our society has enough problems now without more problems given to them, by do gooders with nothing better to Yes I totally disagree with the whole thing; they are taking away our living. Selling cigarettes pays the rent and after all it is supposed to be our shop so why cant we have the advertising of our choice. Not enough profit in tobacco and cigarettes. Not enough people smoke. No one has given me any info whatsoever about the act or its requirements. All I have is hearsay and the occasional press report of a prosecution. If the Qs11-24 in this survey are indicative of what retailers have to do then you might just as well ban.. I would like for the Health Dept to supply stickers for No smoking inside stores indicating to customers especially they cannot smoke in your shop. We get very rude comments. I think the Health Dept should supply free of charge anything pertaining to the Smokefree legislation. What is going to happen when sport is no longer subsidised by tobacco companies. Will taxes go up because of the amount of tax now collected from cigarette sales. Thought selling of single cigarettes illegal. Tidy up the act so all can understand it and so we retailers can enforce the act. Why are they banning advertising of cigarettes & sponsorship of sports etc; they should concentrate on alcohol, it is causing a lot more accidents than smoking does. I am an ex smoker and I do drink alcohol so I am not being biased. I feel that the cig. Q. has received all the publicity it needs & the Dept. of Health and all the others noise makers on the subject would be far better off campaigning to keep our hospitals open & to get the Government of the day to reduce or dispose of all ... 1. Legislation is not foolproof. 2. Too much onus on retailers. 3. Very little emphasis on public education & awareness. 4. It seems like the legislation is driven U by lobbyists only & majority has not been carried along willingly. 5. Must be expensive & burden to tax-payers. U I believe tobacco companies should be allowed to sponsor sporting events in return for having their product advertised. U It is a waste of time & effort which should/could be better utilised on more important health problems, glue sniffing, alcohol abuse, long waiting lists for hospital admittance etc etc. U I agree with the on-going strategies. The rights of the individual are in question. I dont smoke - never have. U Whats the difference between cigarette advertising & alcohol advertising? Both are hazardous to your health. U Firstly - I am selling more tobacco & cigarettes now than I have in the past, even with all the regulations & health warnings. Secondly if the parents who send children down for cigarettes with a note were also made accountable for their U actions maybe The above Qsprobably relate to a period of 2 yrs. when I was out of the grocery trade. I have been managing this store for 9 months & the questions I have U answered relate to that period. Yes, no mention is made of the telephoned order that is packed and then picked U up by children under 16 sometimes. Stickers indicating the restriction on selling cigarettes & tobacco to under 16 yr. U olds should be sent out regularly, say once a year. Personally I see no reason to legislate tobacco industry out of existence. U There should be substitute for advertising in lieu of tobacco company & also increase margin to 33% on sale of cigarettes. U Resent the dictatorial attitude. I believe that the taxes taken from the sale of tobacco & cigarettes should be put directly into the health system rather than be included in the consolidated revenue U of the Government Why is the Health Dept so concerned with smoking anyway when there are U I have noticed that most smokers are women 3/4. I believe that smoking should be the choice of the individual although a non smoker myself. I have noticed a massive increase in the number of marijuana smokers. I believe much of these U increases are stress

I mentioned before - if the legislation were to apply to the people trying to buy the cigarettes illegally as well as the people selling them, retailers wouldnt get such a U hard time. Why should the law be one sided in this matter. Provide us all the details in the mail as soon as possible. U U U U Yes I think it a personal affront and an infringement on personal rights not being allowed to advertise ones products. Also given the intimate nature of corner store owners & their clientele I believe it perfectly acceptable for their kids to buy cigarettes.. Age limit aside I agree with non smoking in public places. However as long as it is legal to smoke & sell cigarettes I do not agree with other restrictions.

Further comments by dairy retailers about the Smokefree legislation are as follows:

The sale of tobacco etc to under 16s is very hard to police because young people now days look a lot older than they are. For a retailer to be fined for selling to an under 16 is very hard on the retailer because they can only go on the word of the etc... More concern should be given to young children who have their lungs tortured by their parents daily nicotine fix. I would like to receive stickers and posters saying that this is a smokefree zone, if this is possible, "thank-you"! Although I do not smoke I feel the right to choose is being taken away and I object to this. My concern is that there is no protection for retailers when selling cigarettes to persons who say they are 16 years or over. It cant be accurately guessed to what age a person is, therefore accurate prosecution cant exist. We retailers must have the right to ask for identification papers in case of doubt of age of young people. Please discourage pregnant women. Discourage smoking around the elderly and small children. Hard to judge the age of some young people, so you refuse to sell to them, then get abused, an I.D.. card system for everyone would be an advantage. Make things easier for everyone. Most of the young women Ive spoken to use smoking as a weight control, etc.. Many smokers are not aware of the rules and do come in smoking to retail outlets. We have to take abuse when telling them it is now law and they feel deprived of their own rights, as it is after all, a personal choice to smoke-all the advertising etc.... All advertising and sponsorship should be allowed if health warning is part of the deal. Like the liquor industry, the customer should have to take half the blame and half the fine for underage sales. With the best of intentions, young people are still going to be served. Public awareness, that they may not smoke in a shop or public place, would be a big help. I am a non-smoker, in fact I have never smoked, tried it once 60 years ago and didnt like it. I think tobacco is here to stay for some time yet, and I would be reluctant to ban smoking by others. This is a legal product to those over 16 years and carries heavy taxation. The more it becomes elicit the more attractive it becomes. So I think the bans are counter- productive. People have switched more to tobacco to reduce the cost rather than give up. I am a non smoker and I think the advertising of tobacco products makes any difference to me. Single cigarette sales should not be opposed -they are often used by consumers to cut down (seems to be effective in some cases) -poor people can only afford a few at a time some customers ask why smokefree money sponsors sport, when they understood it was to be channelled to paying costs of smoke-related diseases. They also question this tax when no similar steadily increasing tax applies to liquor, whose cost to NZ, etc...... If smoking in my shop is illegal, why doesnt the department prosecute a smoker instead of placing all the responsibility on the retailer. re: qs 2 & 3: what information we have is not complete. re: qil: agree to no adds outside shop but not within. I think thats up to the individuals business,not of Government or bureaucrat./if the Government of the day was fair a referendum of/or similar. Cigarettes are that bad, stop all sales of them. Put $2000 and $10000 fines on the person smoking, or the underage smoker. I dont smoke. It stinks! Basically- "all" retailers must be consistent in the manner in which they sell tobacco products. Why is it under 16s cannot buy cigarettes? But theres no restriction on the selling of tobacco and papers? This is according to signs which are displayed etc.. It should not be up to me to be your governor. I am trying to run a shop, not be a policeman for Health Dept. Smoking is an individual right of each person. Government or health boards are taking this right away and dictating their own terms. Money earned from the sale of cigarettes that the government takes each year, is more than adequate to pay for etc...

Yes, I would like to put input into this legislation by suggesting that manager of retail outlet should have full knowledge of the law, similar to liquor act. Also, TV campaign making parents and adults liable to fine and prosecution who send children to purchase cigarettes, etc. The emphasis on smoking legislation is out of proportion to the problem. Most people that I know who started smoking in their teens actually only smoked for a year or two, under peer pressure, then stopped. Not like alcohol that causes not only health problems etc.... As some dairies did have a smokefree sign in their foods area, but selling cigarettes and tobacco is their trade. Everyone has to make a living somehow, some dairies selling a lot of cigarettes and tobacco to pay for their rents. I still agree with tobacco manufacturers (even though they have a vested interest) that smoking does not start because of advertising. Peer pressure is what has to be stamped out with a bit more social engineering.

Operating a dairy, have considered not selling tobacco products at all abut" there are a considerable number of people in their 20s/30s who smoke occasionally. Peer pressure "young to young", 20s to 20s" etc-this might be the quickest way etc... We have trouble determining the age of some young people. when questioning their age, they always deny they are under 16 yrs. So I dont think a retailer should be prosecuted for selling to underage people until such time some sort of I.D.. is introduced. Employ a friendly informative person to visit retail outlets on, say, a monthly basis, to talk to the owners without threats of prosecution. These people could point out anything thats been done incorrectly or could physically assist in correcting etc.... My wife and myself plus family are all non-smokers. In fact, we all hate its smell and odour. As far as Im concerned I think advertising has hardly any effect on attracting smokers. Firstly, if its creating the problems in out society it should be etc...... Ignorance is not an excuse, but I have no real idea about this legislation and its requirements! I am not a smoker, so take little notice of prices etc., up until purchasing this business-youd better send me some information- Ill write requesting some. This whole scene is over legislated and does little or nothing to restrict cigarette smoking by anyone. If the money spent on this ineffective legislation was diverted into smoker education some good may be achieved. I personally think it has got nothing to do with anyone, how-where-when you buy them or where you smoke them. Note: Ive never smoked in my life but its my own personal opinion. It is absolutely idiotic. How can you tell who is 16 years old and who is not! I think that the current television advertising of alcohol and beer is more or just as bad for people as cigarette advertising and should be stopped. The government instead of putting the price of cigarettes up all the time should leave the people to etc... Cigarettes should be in a plain pack. No new brands should be allowed. I would dearly love to be able to afford to not sell tobacco or cigarettes of any kind. However, we are not secure enough yet to do this. Advertising doesnt make people buy cigarettes and young people who start are usually unemployed and under stress. Cigarette companies should be promoting employment opportunities and sponsoring youth in the education and training field etc..... Some means of personal identification, eg: through schools - photo and birthdate. I think that the ban on advertising has not had much effect on sale of tobacco or cigarettes. My sale of cigarettes has remained the same. I think we need to educate people as to the effect of smoking. It must be done in a dramatic manner like actual etc.... Dont you think its the choice of the individual to smoke or not to smoke. I and my wife chose not to smoke. I feel the smoke companies put a lot of money back into the community by sporting clubs, but the buggers are too thick to see the benefits. We should have laws forbidding people to smoke in restaurants and shops. Personally I think the whole smokefree thing is ridiculous. I cant see any harm whatsoever in advertising cigarettes. When it effects sporting activities like it does, just because they have "Benson & Hedges" or some other brand on their cars or etc.. All people who are entitled to smoke must by now be aware of the health risks involved and should be able to choose. Restrictions are an encroachment on their freedom of choice and also adds more hardship to struggling small dairies like ours. I dont like people when they are smoking and come in and buy anything, the smell and smoke puts me off, makes one feel sick. Also bad habit. Also the whole shop stinks. Just stop making cigarettes and alcohol. "No smoke, no drink" life will be much happier for everyone, etc... So far I believe the legislation has been a little vague. I would like to say though, that if cigarette & tobacco advertising is illegal then so too should the advertising and glorifying of alcohol which destroys (in many ways) more lives than smoking, etc... You asked to remove signs, to remove the display of tobacco products, etc. from public eye. But firstly, you dont pay the hefty price that they are, so you naturally want to get them sold. So many people dont know the type of cigarettes they maybe buying. Make the rules hard on the tobacco company and not the retailers. The retailers have got lots of items to sell, therefore cannot just keep an eye on selling tobaccos. Thank-you. Sale and advertising of tobacco products as long as retailer concerned. Retailer should not be charged for breaching the law, at least one written warning by Health Dept $10,000 or $2000 fine is a big amount to pay while very low profit margin in etc...... I would like to see a complete ban on "all" cigarette/tobacco advertising and a ban on new lines of cigarettes. eg: Rothmans have a new brand (holiday) and Wills have a new brand (horizon 25). I think this is wrong when there are already too many brands etc.... In Waitakere City Council smoking is banned inside shops, but we find people have just started ignoring warnings not to smoke and come up with lit up cigarette inside & smoke. Its a bit hard to tell a customer not to smoke. Dear sirs/ladies-through my experience re sale of tobacco products in NZ is short, Id like to recommend strongly establishment of "task force team", covering whole of NZ, to work in the concerned matter much more seriously & develop the knowledge etc..... Separate business & politics- stop the politicians trying to use smoking (or non smoking) legislation to further their own personal careers. Drinking causes possibly more problems than smoking- why are the regulations on drinking being eased? (eg: TV. etc). If a person is under (16 yrs.) and fools the shopkeeper into thinking they are over the age limit. Why are they not liable to prosecution? ID cards are needed. Alright for those that drafted up this legislation, they are not on the other side of the etc... I believe in time the smokefree legislation will make its mark. Under 16 person also should be fined, not only retailer. I think its the most stupid piece of legislation put through parliament. There is no way advertising encourages people to smoke or young people to begin smoking. Peer pressure does that. My husband and I dont smoke, nor do any of our 3 children. Even though Im an ex-smoker, and I dont like them, I think its ridiculous to ban all advertising & sponsorship because one MP did not like smoking. I agree that smoking isnt good for health but I find it very hard being told that I cant etc... I would be pleased if youd put a total ban on the sale and advertising of cigarettes & tobacco or lift the ban & all control & make it is for sale & put a lot more tax up to 500% to 600%. Some sports - non popular ones need financial support to keep going and if the Health Dept. cant - why not let tobacco companies help. Signs available state no-smoking/etc. a customer has commented it is hypocritical when I still sell cigarettes-some ignore it. It would be helpful if a sign was available which states, against the law to smoke in my shop. Basically its up to the individual as to whether or not they smoke. Increased prices discourages smokers. Perhaps a higher ACC levy should be levied. Duty tax increased on company. Its impossible to judge the age. No IDs. How the Health Department expect u to be stuck with the cigarette sales. Lots of mothers send notes or older friends buy cigarettes for under 16s. Its up to each person if he wants to smoke or not. There should not be any restriction on selling cigarettes singly,because person ends up buying full packet of cigarettes & ends up smoking full packet as being handy in his pocket or in her purse. As we have no idea what the smokefree legislation is, we would like clarification on smoking & non-smoking areas in cafes, tearooms, etc- ie: is it ok in half of ,the place to smoke and not in the other? Suggest immediate removal of all cigarettes, advertising signs or posters installed, in or outside of the retailers shop. It should be made illegal for persons under 16 to purchase tobacco products, more so than for retailers to sell them. After all they know their age, we dont. Present legislation is designed only to punish the retailer rather than the real offender. Drink kills more people a year? Advertising should be of minimum exposure. Hefty fine for selling to under 16s Due to the fact that we have just purchased a dairy and we dont really know the legislation, we cannot comment. From the financial viewpoint cigarettes are a way to loose money (profit on cigarettes about 7-10%); $4000 (usual stock) invested in banks up to 15% return with no security risks) only the Government profits-70-80% tax. I would rather sell $5.30 worth of chewing gum etc.... Waste of time- has no teeth!! There is no penalty for the offender, offender being the person under 16 years of age. I agree that retailers should display whatever signs or notices regards the sale of cigarettes to under 16, but I dont agree that it be our responsibility to have to question people of age, the public should be more aware of the law fully so that etc...... With user pays Government policy the choice should be up to the individual and may be a limited amount of advertising be allowed and sponsorship allowed of sports. "non smoker". Would like to see it banned from supermarkets, dairies, food outlets, etc. To be restricted to tobacconists only or some other specialised outlet. For me personally, uses so much of cashflow for so little return. Plus the fact its a health hazard, pollutes air. Its ludicrous, that vast sums of money are being spent on a vendetta against tobacco companies, and a ban on all tobacco advertising when at the same time the Dept. of Health havent raised a murmur against alcohol consumption which is responsible etc..... I regard the legislation as a gross infringement of my independence as a retailer. I have no sympathy with cigarette smokers, on the industry as a whole, but I abhor even more legislation that tells me how to run my business etc... Unless you ban smoking altogether you will never stop under 16s smoking. The 7th form pupil will get them for the 3rd form pupil. The parents will provide. Retailers struggling to survive financially will sell them. This law is impossible etc.... The gist is to educate youngsters from taking up smoking. Hit them hard and keep reminding them. To keep increasing the price of cigarettes & tobacco is stupid- you are just making matters worse. Those who cant buy it will grab it. Only to state that the legislation should also apply to liquor sales for very obvious reasons. Much more chaos, despair and life destruction is created through alcohol sales as compared with cigarettes, etc. This is supposed to be a free country. Not told what and when we can do something. As for age, kids 16 years of age usually buy cigarettes for 14 & 15 year olds anyway. There is nothing we can do about that. All retailers should stop selling single cigarettes and not sell to children for parents benefit. Liquor should have the very same restrictions as cigarette and tobacco products. In my view far more innocent people are killed tragically through the effects of alcohol abuse than through passive smoking. "You" have made it cool to flaunt the "16" law. Go back and allow sponsorship. Save all the money you are wasting on inefficient expensive campaigns for hospital and general public health but retain warnings on tobacco products & in advertising. As I said earlier that if it wasnt illegal then a lot of the young ones wouldnt smoke because it wouldnt be against the norm. I dont see anything wrong with tobacco advertising, as long as it is inside the store. We rely on the tobacco company representative to tell us what we can and cannot do. We presume he has had all the relevant information- we have not. We are in the same predicament as bartenders- how to tell if people are under 16 years. The ban stopping under 16 year children buying cigarettes should be lifted. Children that smoke tend to be able to get cigarettes regardless of age. I personally dont sell cigarettes to children under 16, but they just go elsewhere to get them or etc...... High schools pupils should be made aware of smokefree legislation and advertising gimmicks-so its a two way-thing. Excessive and push around tactics only have a reverse effect - plain straight forward signs and legislation are all that is required. I think control over anyones wish or desire is undemocratic. Therefore I feel there should be no restrictions over smoking. More ruining and devastating is lotto, I betting & liquor which have very liberal controls. No advertisements to be allowed to be put inside shop when the reps come on their monthly call and no other product to be introduced other than that is available on the market and no new II brands and no new packets. We find that we ask for proof of age and they cantgive us this. We say sorry and II then they go to the service stations who will serve all and ask no questions. I think this survey is very biased if filled out by a retailer as he has his sales and profits in mind and therefore would want to advertise the tobacco he sells as he II does any other product. I see groups of teenagers standing outside the shop. The over 16 year old comes in II buys the cigarettes and simply distributes them to the rest. The regulations are a total waste of my time. Have put me in dispute with legitimate customers. We agree that smoking is bad, especially in young children, but it doesnt seem fair II that we have to police the sale of cigarettes and if we dont or even make a legitimate mistake, we get penalised. II Believe it or not I have "never ever" had a cigarette in my life. Im 44 years old, but I think all this fuss is over nothing. People will smoke if they want and the more you ban it the more it will become like drugs. Why cant they sponsor sport? 111 It is really hard to tell if a child is over 16 years. It usually turns into a confrontation. If we could find a way to avoid this, such as put age up to 18 years and enforce it, but only prosecute if under 16 years. Being a non-smoker (for 15 yrs.) I feel its a persons right to sell, buy or otherwise, as long as its within the law & guide-line set down. Anyone should be able to do what they wish, within certain limits. I agree with no smoking in public places. I would like the age restriction ruling cancelled as its very very difficult to police it. If people say they are over 16 they dont usually have anything to prove the fact anyway. I would challenge anyone from the Dept. of Health or Government to visit etc.... II Im a non-smoker, however I believe people have a choice, if they choose to smoke, with the health warning clearly advertised on signs & packets then its their right. Asking retailers to be policemen & having a fine hanging over our heads is I etc.... There is a thin line between a persons privacy and freedom with smokefree II legislation. We are fed up with requesting that customers dont enter out premises with lit cigarettes as we have the compulsory smokefree area signs up outside & inside our II dairy. We are sick & tired of them getting angry at us. We have also lost customers for this , etc... II Difficulties can arise with young people unable to provide ID and who are 16 years of age. Birth certificates can be borrowed and many young people dont have drivers licences at 16. Also if they may have left school so dont have school ID. I

11 Smokefree sponsorship is a sham in a lot of cases. School and junior te.m sponsored by smokefree have a high incidence of students who smoke openly. Parents should be more responsible to children in their smoking habits. Seeing parents smoke encourages children to do likewise. I think the law as it stand is enough. Retailers have enough problems complying with the regulations concerning underage customers and what to display or not, to cope with, without adding more. Im not a smoker & never have been. I get sick of all this carry on about smoking. I wish the Health Dept. would leave smoking alone & do something about alcohol. People are only harming themselves smoking but the young ones that drink harm themselves etc...

Ban the sale of all tobacco products to everyone under 25 years of age. This is the only way I can see a decrease in the number of high school pupils smoking. How do you get idle MP to listen? Our shop has been broken into 12 times in 3 yrs. to steal cigarettes, etc.... We have been abused and sworn at quite a few times when we were in doubt about the age. What should we do? I dont think that the Government is being honest about its free market philosophy. I also dont like the feeling that retailers are targets for the catching out in selling to underage when theres no effective way of telling how old this age group is. I do not like being told what I can or cannot do in my shop. I dont believe the advertising of tobacco products is a bad thing, they allow a lot of sponsorship with their products, because nowadays people smoke less because its antisocial to smoke so people make the choice for themselves. I think the legislation is stupid, as I cant see it stopping people from smoking. If the advertising of tobacco products is banned, then why allow companies such as Winfield and Benson and Hedges to promote sporting activities: there should be "no" exceptions. More education and less regulation. General comment- over the years we have been told each generation is better educated than the previous ones. How is it that we have more regulations than before??? If that being the case we should have less regulations. I think its a ridiculous legislation, and defy your researchers to pin point ages of teenagers between 15 & 17. All one can do is ask their age & take their word. It would be more advantageous to prohibit cigarette companys producing packets smaller than 20s.etc.... I think it is unfair to expect shopkeepers to have to interrogate people as to their age when buying cigarettes. Youre doing a good job! My daughter works in a hospital and sees (many people)- who have had trouble from smoking, but do they listen - no!- Im sorry to say. I read of "statements of intent" rather than "policy". Therefore I cannot answer "agree" to statement of intent to disrupt cigarettes retailing-the difficulty of obtaining cigarettes for under 16 yr. olds must be only one reason for shop breakins etc... I dont believe that advertising increases smoking. I dont think that the retailer is responsible to judge a persons age. I dont agree with smoking I gave it up 20 yrs. ago. I think that parents are responsible. You could prohibit sales to persons in etc.... We will find this very hard to do as our shop has very limited space. I think that as long as the product is not placed in a conspicuous place in the shop, eg: like loffies,etc, it should be alright. I disagree with the whole concept of smokefree legislation. It takes away the freedom of any number of people to live life the way they wish. 1) referring to q.20., I reiterate that it should be made ifiegal for children aged 16 & under to smoke. 2) cigarettes shouldnt be allowed to be packed in less than 20 per packet. Current 10s, 14s & 15s are becoming a good starting point for smoking. The sale of 10s encourages youth to smoke. I dont think all retailers can or should be held at ransom by way of fining. I think the education should come from the home. If they want to hold parents responsible for crimes then here is their chance, not the shopkeeper. If people are going to smoke they will. Complete ban on advertising will not stop people from smoking. Breathing, petrol & diesel fumes, drinking & drugs to me are more deadly than tobacco will ever be. This seems to be one persons vendetta against smoking, etc...... New Zealand has too much unemployment now = take away tobacco sales and it will ever rise. The control of where & where not to smoke is quite sufficient as it is. The legislation is shallow minded and bigoted. The choice should be left to the individual. The owners should definitely not be left to judge age, etc. If a person wishes to smoke that is their perogative the same as eating,drinking, etc. I am aware of shops in the Nelson area selling single cigarettes- I feel this is illegal as this takes place without a health warning. I feel it should be stopped, or else opened up so everyone can do it legally. Customers come & ask for single ones etc...... Widespread information about the ill effects of smoking cigarettes & tobacco by:- newspapers & magazines; radio & TV; through schools, colleges & universities & churches. If possible decrease the production of cigarettes & tobacco & impose a high sales etc.. Use more radio ,TV & newspaper advertising about smoking cessation groups & clinics, plus anti-smoking programmes done in segments on TV in Finland they have a "cessation contest". Ask smokers to stop for 2 weeks. Name goes towards winning a trip.etc.. The sale to under 16s is such a grey area, ie: if in doubt dont sell would be the most difficult problem staff & management have in policing. If a note is signed by parents the responsibility is then the parents. All signs that have no health warning have a warning attached. Allow sponsorship of sports and other activities. To ban the sale of single cigarettes would be hard for those giving up. Most find it easier to know they have only to buy one smoke if the urge is there rather than a packet of 10, as these people have usually had a cut down process. I have removed most of the posters from shop over the past two months, and no longer sell any tobacco or cigarettes. My customer count and sales has fallen off by 30% (could be 50%) over a three week period. Cigarette sales are the life blood of small dairy etc...... Q.26/I thought it was illegal to sell singly. I think smoking should be banned to everyone. When you decide to pay the rent for my premises then you can tell me what to do. Until such time as you do I will make my own decisions on what to and what not to display. I have enjoyed helping in the survey. I am new in business and was unaware about the putting up of new signs and how there is a penalty for this. If you have time please clarify this matter with me sometime. I have not done this but I need to know more etc.. 1) the under 16 issue it must be the parents responsibility; 2) the tobacco companies are making fools of you people. There are over 60 brands of different cigarette packets. They are bringing out new products monthly this year "cutting" the "price" of etc.... The legislation is confusing-read it once some time ago well prior to starting business. Restriction & sale of tobacco products is unrealistic in comparison to alcohol which is a mind bending drug. Drinking of alcohol is socially acceptable & is far more dangerous to others. We believe that if its legal to sell a product we should be able to advertise it how & where we choose in o ir shop, provided it carries a Government warning. Further we dont believe 1 e onus should be solely on the shopkeeper to deter under 16 yr. olds etc...... Advertising of tobacco products doesnt make people smoke so I cant see why they cant be displayed. Also they keep many New Zealanders in work. If breweries can sponsor sport why not tobacco companies? If people want to smoke there is nothing I can do. Shop advertising is not going to start a person smoking, only what brand theyll choose. U I think the Government should encourage school education about smoking. The 16 year old restriction will not prevent young people smoking or obtaining cigarettes. U re: q.12/this could also prevent shops from maintaining a tidy appearance as old advertising becomes tatty, etc.. There is no way we, the retailer, can tell the age of a person and to suggest that we U can be prosecuted for selling to under 16 yr. olds is ridiculous. Its about time that responsibility is shared by all including parents, schools & any other interested etc... U All advertising must stop now. All signage including an electric Rothmans display (costing $7000) was removed from our shop some years ago much to Rothmans annoyance. We have no cigarettes on display but tobacco is still visible. U The legislation is restrictive if the people wish to smoke, whatever age, they will. Prohibition in the States. It also seems to bring out a breed of self-righteous U persons who, probably because they are unemployed, spy & report on fellow citizens. U We havent had the business long, so would require all information available. It would be beneficial if they would go to the source and prevent cigarettes being imported and manufactured in New Zealand. U re: question 7/I ask them if they are 16. You know what the answer is and you cant tell us you have never lied. U 1) single cigarette sales should be banned; 2)some retailers selling less than suggested retail price. Are they allowed to? If not, what action is the Dept. taking U to stop them doing it? If yes, then why are companies publishing the retail price? We consider that the advertising of tobacco products inside a retailers premises is his own business and should be left entirely to his own discretion. U As a retailer its easy to control advertising inside and outside of the shop. But one thing very difficult is to judge age. Another is when they have parent waiting in car U and not to sell smokes.

As a smoker of 35 years, I can still reflect as to why I started to smoke; and it certainly wasnt as a result of advertising! From my own observations I would U believe that to be true of virtually all young smokers. If tobacco companies want to give sporting bodies money for their sports and can U advertise while they are doing so, well that should be okay. I wouldlike to know, how can you control customers smoking in your shop when U you sell them the product? This is a very annoying problem & should not be the responsibility of the shopkeeper. Understand thats not lawful or okay with the Health Department to sell cigarettes U singly.

It is better if the law was left before the smokefree legislation or put a total ban on U producing tobacco. U U B Smokefree legislation is setting a bit carried away. People are losing their rights to make decisions without influence. At least it keeps someone in a job, give them work to do.

Its hard to find a happy medium in this problem of tobacco selling. With all these legislations, laws, dos, donts, warnings and fines; make it very hard for the retailer to face their customers who look younger than 16 yrs. of age. Legislate to give retailers a greater share of profit (ie: more than current 11.71%) on cigarettes. Shock advertising on TV-lung operations involving 60 year old smokers!! Whilst Im a non-smoker I dont mind if others wish to smoke as long as they do it where it wont affect non-smokers clean air. Im all for some form of ID for younger (and older) people so we dont have the continuing hassle with people who might etc..... Since the age restrictions came in I feel that more people under the age of 16 years have been made into criminals by lying to me about their age. As is proved by the liquor laws putting an age restriction on creates peer pressure to try cigarettes/etc....

I think that the smokefree legislation on advertising should be scrapped. if people dont know what they are doing to themselves by smoking, with all the advertising on the TV, on cigarette packets & teaching children at school etc... If tobacco related products become over regulated small businesss will go bankrupt. The profit made from the sale of cigarettes is minimal-however that trade is required for impulse buying of other products. Take this facility away & shops may as etc... I feel advertising should be allowed provided it carries a health warning message. Its each individuals right to decide whether to smoke or not & advertising the sale or sponsorship of tobacco does not force people to smoke, if the legislation is to continue along this format which has repercussions to sports sponsorship. I think the cigarette companies are making your job harder as they keep coming up with new, cheaper, smaller packs etc. to encourage people to keep buying while Health Departments are trying to slow down & stop people. We are not policemen & cannot police their ages. Parents should take some of the responsibility in children buying smokes as they teach their kids its ok to lie & if the parents had to pay a fine as well they would be more strict on behaviour outside etc.. With regard to the sale of tobacco products, I find it bloody annoying that an under 16 policy is implemented without any apparent forethought. Have those who brought in this policy stood behind a counter with a large high school population & without etc...

While I totally agree with the objectives of the smokefree legislation other sellers must be reluctant to support fully legislation that actually reduces their turnover & profitability in hard times. Also when one considers that many of the smaller etc.... We often feel "in the middle" of things between the law & tobacco companies. The tobacco companys obviously "try" out the law to see what they can get away with & if say Rothmans lawyers get something okayed Wills will do it. Some adults in the area are knocking off smoking. Teenager smoking is still at the same high percentage. It there are signs relating to under 16 yr. sales of cigarettes best not to have stick on ones, so that these can be moved if renovations occur in that business. Stats related to the lesser incidence of teenage smokers. S/B sent to businesses & wholesalers.etc.... I believe that people who smoke are going to continue smoking regardless of how difficult it becomes to obtain cigarettes. As for sporting events not being able to be sponsored by tobacco companies, I disagree. None that smokers would appreciate. Selling cigarettes has caused us 4 burglaries. After having "barred" our windows & doors a hole was cut in the wall. We have a burglar alarm system with 4 sensors & 3 alarms. 1) MPs have the wrong end of the stick as usual & penalise the wrong people; 2) retailers really dont have the time to take this on board; 3) if this legislation does stay, impose restrictions on the customers & tobacco companies & get off my back. We would like retailers to be able to leave advertising inside the premises as well as outside unless the Government decides to make all tobacco products illegal to be sold. If possible, we would like a reply stating the viability of our wishes. Stop sale of cigarettes singly. Minimum pack 10 size. Trying to trap retailers by sending in young people, as its difficult to tell age, we like many refuse to sell, but it can be difficult. We are in business just like publicans! If the people of New Zealand had a free health service then I could probably agree with most questions but when we are controlled by a dictatorship it is difficult to act as a policeman or lawmaker. My doctor and medicine cost at times, unbelievable amounts. Appendix 6

Smokefree Sponsorships undertaken by the Health Sponsorship Council (1991/92) E45 Sponsorships Undertaken

1992 AMP Golf open, Associate Sponsor 1992 Isola International Festival 1992 Lifespan Mountains to Sea Ultra Triathlon 1992 Royal Easter Classic Showjumping 1992 Smokefree Rock Quest 1992 Underwater Hockey World Champs 1992 World Trampoline Championships Air NZ Shell Golf Open, Associate Sponsor Aorakj Festival at Holme Station Aotearoa Maori Performing Arts Festival Arohata Womens Prison Drama Project Artemis Productions, Arrows & Bows Season Asthma Foundation Stavwell Achievers Award Athletics New Zealand, Secondary School Athletics Athletics New Zealand, 1992 Track & Field Champs Athletics New Zealand. Cross Country Champs Coverage Athletics New Zealand, Secondary School Athletics & Cross Country Auckland Secondary School Junior Basketball Champs Bay of Plenty Football Association Coaching by David Edge Belladonna Productions, Belladonna Season Cariterbui-v Lawn Tennis, Honda League Team Canterbury Rowing Club Capital Discovery Place, Confidence Tower Catherine Chappell & Dancers, Cumulus Season Christchurch City Council, Community Walk Christchurch City Council, Recreation Festival Christchurch Youth Council, Youthcard CIT, Smokefree Air Festival Cosmopolitan Bowling Club Open Fours and Open Pairs Counties Manukau Sports Trust, Fair Play Certificates Cycling NZ Canterbury, 1992 Track Champs Dame Malvina Major Foundation, Associate Sponsor Diabetes Auckland Project 2000 Downstage Theatre Trust, Lysistrata Season Downstage Theatre Trust, Pack of Girls Season Dowse Art Museum, Big Green Exhibition Dunedin City Council, Community Events Programme Dunedin City Council, Moana Pool Activities Programme Eastern Southland Hockey, Signage Edendale Dart Club, Tournaments Facial DEX, National Tour Footnote Dance Company, South Island Tour Gisborne Basketball Association, Mens 2nd Division Team Gieniti Golf Club, Tournament Hamilton Coming of Age Carnival Havelock Fastpitch, Youth Coaching Programme Hawkes Bay District Rugby League, 1992 Season Junior Teams He Ara Hou Maori Theatre, Whatungarongaro Tour Health Promotion Forum, Investing in Health Conference Hillary Commission, -Girls Address Book Hutt Valley Table Tennis, Championship Teams and Coaching Programme Ice Racing Federation of New Zealand, Speed Skating IHC, Charity Golf Tournament 18th Hole Ivan Mauger International Champion of Champions Ivan Mauger International, NZ Long Track Speedway Joyful & Triumphant National Tour Kapiti Rugby League Club, 1992 Season Karaka Bowling Club, Open Fours Tournament Kiwi Sports Mania, Signage Lambton Harbour Triathlon Coverage Lateral Spread, Inner Circle Season Levin AFC, 1992 Season Lifespan NZ Writers Week Maidment Youth Theatre Summer Season Mana Community Arts Council, Footrot Flats Festival Ma.nukau City Council, Recreation Division Manukau City Council, Secondary School Cultural Concerts Maori Cultural Smoking Cessation Programme Maori Sportswomen Profiles Marlborough District Council, Recreation Festivals Master Rowing Champs Coverage Matakos Netball Association, Health Day MDC Maori Sports Person Awards Coverage Mike McCleary, Schools Tours Military Marathon World Record Attempt Coverage

Page 21 M r. qo issevich Youth Ballet Trust, Classical Sparks, Dance Reach Out 1 & 2 Mt Maunganuj AFC, 1992 Junior Coaching Programme Mt Maunganul Contract Bridge Open Tournaments Murray Halberg Trust, NEC Sportsman o(the Year Coverage Music Federation of NZ, Schools Programme Napier City Heat Basketball, 1992 Season Napier Judo Club, Mat Signage Napier Junior Rugby Board, Coaching Booklet Nelson 1992 Womens Waterfront Challenge Nelson Softball Association, Provincial Meils and Colts Squads Netball New Zealand, Age Group Tournaments New Zealand Endeavour Whitbread Challenge Nomis Productions, Taming of the Shrew Season North Island Coast to Coast Endurance Race, Co-Sponsor North Shore City, Recreation Festival Northland Touch Association NZ Badminton, National Champs NZ Basketball Federation, Summer Training camp NZ College of Midwives, Conference Signage NZ Drug Foundation, Media Advocacy Workshop NZ Federation of Sports Medicine, Rugby Medicine Conference NZ Federation of Sports Medicine, Stationery NZ Fire Service Rugby/NetbaU Tournament NZ Hockey Federation Womens Hockey in New Zealand NZ Horse Society, 1992 Horse of the Year Show NZ Judo Federation, Oceania Champs NZ Maori Womens Welfare League. 1992 Netball Tournament NZ Marching Association. Judges NZ Marist Rugby Football, 1992 Season Team NZ Puppet Theatre, Schools Programme NZ Rugby Football Union, Maori Rugby NZ Rugby Football Union, Rules Book NZ Rugby Football Union, Womens Rugby in New Zealand NZ Rugby Referees Association, 1992 Season NZ Short Course Triathlon Champs Coverage NZ Sports Foundation, Fellowship NZ Surfriders Association. National Teams NZ Swimming Federation, 1993 Age Group Champs NZ Sw imming Federation 1993 Division 2 Age Group Champs NZ Yachting Federation, Programmes NZ Yachting Federation Womens Keelboat Racing Otago Cricket Association NSW Tour of Southland Otago Tennis Association, Honda Tennis League Team Paremata Boating Club, Easter Regatta Parihaka Netball Club, 1992 Season Teams Penwomens Club Recreation Association of NZ, 1992 Conference Royal NZ Police. Operation Heart 92 Rugby Union Foundation, Training Video Run to the Top - Jogging the Lydiard Way Video School Visits by Craig Innes, Rugby League Sir Edmund Hillary Outdoor Pursuits Centre, Brochures Smokefree 6th IAU World Crossbow Champs Smokefree 1991 Floriade Pipe Band Contest Smokefree 1991 Mast,erton Motorcycle Street Races Smokefree 1992 Age Group Swimming Champs Coverage Smokefree 1992 Marist Spillane Rugby Tournament Smokefree 1992 National BMX Champs Smokefree 1992 National Synchronised Swimming Champs Smokefree 1992 NZ Amateur & Professional Ballroom Dance Champs Smokefree 1992 NZ Boxing Champs Srnokefree 1992 NZ Contract Bridge Pairs Tournament Smokefree 1992 NZ Squash Open and Womens Open Smokefree 1992 Rock Challenge Srnokefi-ee 1992 South Waikato Super Sports Competition Sznokefree 1992 Ultraman Triathlon Sinokefree 1992 Womens Open Surf Title Smokefree 1993 NZ Pony Club Teams Horse Trials Smokefree All Star Celebrit y Basketball Games & Free Coaching Clinics Smokefree Auckland Primary & Secondary Triathlon Champs Smokefree Basketball Summer Camp 1992 Smokefree Beach Volleyball Team - Bruckner & Ranfurly Smokefree CANZ Rugby Series Smokefree Centennial Club Water Polo Champs Smokefree Commonwealth & Oceania Amateur W Smokefree Cycle Classic, Wellington 1993 eightlifting Champs Smokefree Division 2 Age Groups Swimming Champs Smokefree Head to Head Triathlon Smokefree International Track Series 1992 Smokefree International Track Series, 1993 Sm okefree Mixed Social Grade Basketball Tournament Smokefree National Maori Choir

Page 22 --cflQj55j4 Smoke National Surfing Champs Smoke Winter Swim Meet E45 free North Island Judo Champs - Smoke North Island Summer and Winter Swiznmii Smokefree NZ Team in the 1992 NZ Post Cycle Champs Smoke NZ Triathlon Champs and Classic SznOkefi-ee NZ Water Polo Champs Rankings SmokefreeNZ II Youth Jazz Smokefree PlC Orchestra Netha Team, 1992 Season Smokei Porij- Youth Mixed Touch Team Smokefree Ride ii Tie Multi Event Smokefree Secondary Schools Girls Soccer II Smokefree Senior Artistic Tournament Gymnastic Champs Smokefree South Island Derby Sinokefree Southland Horse Trials and Points Prize Sinokefree Sport Series, Second Series II Smokefree Summer Music Contest Srnokefree Swedish Flag Sm International Diving okefree Teams of Ten Small Bore Rifle Shooting S mokefree Trans Tasman Indoor Cricket Test Series Smokefree Trans Tasman Junior Archery Test I Smokefree Trans Tasman Kneeboard Riding Cup Smokefree Under 19 W Smokefree omens Soccer Tournament (Waikato Only ???) Waihoja Perch Fishing Classic Smokefree Wa II Smokefree inujomata Rugby League Team, 1992 Wajtakere Basketball Team, 1992 SeasonSeason Smokefree Wellington Rugby League Team, 1992 Srnokefree Wellington Under 19 Season Srnokefree Womens Softball Team Womens Beach Volleyball Team - Green & Taylor Smokefree World Cup II Whitewater Slalom Canoeing Smokefree World Masters Surf Lifesaving Champs Southland Basketball Association W Southland Softball Association omens Team Womens Team Sovereign Assurance Mile Series Coverage II Sport Bay of Plenty, Programmes Sport Central Districts, 1992 KiwiSpor-t Festival Sport Counties Maziukau , Have A Go Day Sport Nelson, Sports Team of the Year II Sport, Northland Harbour Day Sport Otago, Sports Sp Development Clinic ort Taranaki 1992 Family Masters Games Sport Waikato Tainuj Programme Sport Waitalcere, Faii-play Programmes 11 St Heliers Bowling Club, Tournament Tai Tapu Motorcycle Club, Sprint Super X Taranaki Area Health Board Taran Exercise Directory aki District Rugby League Under 15, 17 and Rep II Tauranga District Council Have A Go Day Teams Tauranga Hockey Association Signage Te Ao Hou Marae Te Whanganui Waka Regatta Kotahitanga 0 Te Wajrua ACROSS Summer I Te Rakau Huma 0 Te Wao Tapu, 1991-2 National TourCamp Terradactyl Theatre, North Island Schools Tour Tez-radactyl Theatre Wellington Schools Tour The Royal NZ Ballet, Forging Ahead Season The Royal NZ Ballet, National Tour of Hamlet the Ballet II Three Cats and a Dog Plus Margaret Urlich Tour Timar,j Harness Racing Club, Race Tirohanga Netball Club, Senior Team Toa Ba T sketball, Wellington Inter City League Teams II ongariro Rugby Club, Senior A, B, Under 21 and 19 Teams Tuarangawaew Schoolboys Combined Sport Turangawa Regatta Programme Victoria Motorcycle Club, Sprint Meeting Li Vogelmorn Bowling Club, Gala Day Volleyball New Zealand Indoor Volleyball in New Zealand Volleyball New Zealand, Volleyball Season Waikato Golf Association Junior Program Waikato Sc me hoolboy Rugby League, Under 13 and Under 15 Teams II Waikato Warriors Basketball, Spring Valley Womens League Team Waiopehu College, Schools Rugby World Cup Team Wellington Area Health Board, Signage Wellington Hockey Association Event Caravan Wellington Netball Union, Draw Booklet I West Coast Basketball Association, Junior Teams West Coast Softball Umpires Association, Western Bays Softball, Under 12 Girls Team 1992 Season Western Water Education Trust, Learn S to II Western Water Education Trust, Starsi wim Program Wheeling for Gold, ParalYmPics m Relays Woburn Bowling Club, Gala DayDocumentary World Crossbow Champs Coverage II

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