Attitudes Towards Tobacco Harm Reduction Products in New Zealand Insights from the New Zealand Public and Healthcare Professionals
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Attitudes Towards Tobacco Harm Reduction Products in New Zealand Insights from the New Zealand Public and Healthcare Professionals A Report by Frost & Sullivan March 2019 CONTENTS About this 3 Report Smoking in New ENDS and Zealand Tobacco Harm 5 8 Reduction (THR) Attitudes Use of ENDS in Towards THR Tobacco Harm 10 Products 13 Reduction The Last Word Appendix: About 16 17 Our Research 2 Attitudes Towards Tobacco Harm Reduction Products in New Zealand ABOUT THIS REPORT Almost 600,000 New Zealanders still smoke, with a significantly higher smoking rate among the Māori and most economically-disadvantaged communities. In common with most developed countries, over recent many. About 60% of smokers wish to quit, but most find years the New Zealand Government has made deter- this challenging, making over six unsuccessful attempts mined efforts to reduce the national smoking rate. These on average. Adding to this is the sizeable group of smok- policies have helped to drive a significant reduction in the ers (40%) who are unwilling or unsure about quitting the incidence of smoking in the country, from around habit, either because they enjoy smoking or because one-third of the population in 1983 to less than 15% in they recognise they are addicted.6 2017/18.1 Although methods of measurement differ slightly, the rate in New Zealand parallels Australia The difficulties many smokers face in quitting and the (14.9% in 2016),2 but is ahead of all but one of the presence of a cohort of smokers unable or unwilling to European Union (EU) countries, including the United try, as well as the significant health risks associated with Kingdom (17% in 2017), Germany (25%), and France smoking, are drawing increased attention towards Tobac- (36%).3 Across the Organisation for Economic Co-opera- co Harm Reduction (THR) interventions. THR products tion & Development (OECD) countries, New Zealand has provide nicotine in a less harmful way than conventional one of the lowest rates of daily smokers at 13.8% of the cigarettes for smokers who are otherwise unable to quit. population.4 These include products known as Electronic Nicotine Delivery Systems (ENDS), such as e-cigarettes and While significant progress continues to be made, it is heated tobacco products, as well as other THR products recognised that more needs to be done. The Govern- such as Swedish Snus. ENDS products provide an ment-led Smokefree 2025 goal, launched in 2011, experience (often known as vaping) much closer to that aspires to achieve the stipulated target smoking rate of of smoking a conventional cigarette and may be effective under 5% of the adult population by 2025. Realising this when other approaches such as NRT have failed. In goal, however, is likely to be challenging based on jurisdictions such as the UK, usage of these products is current trends. Almost 600,000 New Zealanders still being supported as a central tenet in tobacco control and smoke, contributing to 5,000 deaths a year from smoking tobacco harm reduction policies. or second-hand smoke exposure. Smoking rates remain disproportionately high among Pacific Islanders, the In New Zealand, ENDS products have been in a regula- Māori population (particularly Māori women) and the tory grey area for several years. While technically illegal most economically-disadvantaged New Zealanders. under the Smokefree Environments Act 1990 (SFEA), More recent initiatives to accelerate the decline in smok- this law was generally not enforced, meaning these ing rates by increasing tobacco prices through excise products have in fact been generally available, although rates have been widely regarded as ineffective and unregulated. However, following a recent court ruling regressive by parliamentarians and government commis- (Philip Morris (NZ) Ltd v Ministry of Health [2018] NZDC sioned review bodies.5 These issues play a part in the 4478) which found that a specific ENDS product could be notably poorer health and financial outcomes in these lawfully sold, the Government is moving to place regula- groups. tions surrounding the sale and use of ENDS products onto a firmer regulatory footing, including introducing While many smokers want to quit the habit, successfully regulations about their sale and use. This may drive doing so can be difficult, with current approaches such as enhanced awareness and usage of ENDS products in nicotine replacement therapy (NRT) often ineffective for New Zealand. 1Ministry of Health, Health Survey, accessed from https://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/surveys/new-zealand-health-survey 2Australian Institute of Health and Welfare, National Drug Strategy Household Survey, 2016 3European Commission, Special Barometer 458, Attitudes of Europeans towards tobacco and electronic cigarettes, 2017 4OECD data, Daily Smokers, accessed from https://data.oecd.org/healthrisk/daily-smokers.htm 5New Zealand Treasury Tax Working Group Interim Report. Page 77: https://taxworkinggroup.govt.nz/sites/default/files/2018-09/twg-interim-report-sep18.pdf 6Frost & Sullivan, Consumer Survey, November 2018 3 Attitudes Towards Tobacco Harm Reduction Products in New Zealand To gauge the level of understanding of and attitudes familiar. There is a widespread view among HCPs that towards THR products, in particular ENDS, we surveyed these products are significantly less harmful than individuals (comprising a representative sample of New conventional cigarettes (on a 10-point scale where 10 Zealanders aged 18 and over, and referred to as equals more harmful and 1 less harmful, the average “consumers” in this report) and healthcare professionals rating for E-cigarettes is 2.92 and 3.62 for heated tobac- (HCPs) in New Zealand. We interviewed 535 consumers, co products).8 This opinion, however, is not shared by representatively split between current, former, and never consumers for all ENDS products, with heated tobacco smokers, as well as 60 HCPs, including 20 GPs, 20 products, in particular, seen as being more harmful than registered medical specialists and emergency room conventional cigarettes (average rating of 5.30).9 The physicians, and 20 other HCPs (including registered finding suggests consumers’ lack of awareness and nurses, dentists, and pharmacists). Details of the understanding about the evolving scientific research into consumer and HCP samples can be found in the Appen- other non-combustible alternatives, and probable lack of dix. understanding of the causes of harm from smoking. Our research highlights a broad consensus among HCPs, in general, are highly supportive of the role ENDS respondents (except among smokers) that smoking is can play in reducing tobacco-related harm. Almost still a major public health issue in New Zealand, and that two-thirds (65%) surveyed believe that smokers who are the Government needs to do more – 90% of HCPs, 78% unable or unwilling to quit should switch to ENDS of never smokers, 64% of former smokers share this products instead of smoking conventional cigarettes.10 view; while only 42% of current smokers agree.7 Aware- There is also widespread agreement that both HCPs and ness of ENDS products is reasonably high, especially smokers and their families should be made more aware e-cigarettes, with 90% of HCPs very or somewhat of these products. 7Frost & Sullivan, Consumer Survey, November 2018 8Frost & Sullivan, HCP Survey, November 2018 9Frost & Sullivan, Consumer Survey, November 2018 10Frost & Sullivan, HCP & Consumer Survey, November 2018 4 Attitudes Towards Tobacco Harm Reduction Products in New Zealand SMOKING IN NEW ZEALAND Cigarette smoking is the single most preventable cause In March 2011, in response to a Parliamentary enquiry, of ill-health and death in New Zealand. Each year, around the Government adopted the Smokefree 2025 goal for 5,000 New Zealanders (or 13 a day) die because of New Zealand, which is usually defined as reaching a smoking or second-hand smoke exposure.11 Cessation is smoking rate of 5% or less of the adult population (15 recognised as the optimal approach to reducing the harm years and over; smokers are defined as those who have caused by smoking. The New Zealand Government, like smoked more than 100 cigarettes in their lifetime and most other developed economies, has progressively currently smoke at least once a month). Since 1983, the introduced a series of measures to reduce smoking smoking rate has declined from 33% to just under 15% in prevalence. Efforts include the ban on cigarette advertis- 2017/18. Recent national statistics indicate a slowdown ing on TV and radio from as early as 1963, the launch of in smoking decline rates, with almost 600,000 New health warnings on cigarette packets in 1974, and Zealanders still smoking,12 suggesting that the Smoke- reinforced in 1987, and the introduction of standardised free 2025 goal is unlikely to be achieved by 2025. Recent packaging in 2018. modelling studies show that on a “business-as-usual” basis, the smoking rate will reduce to 8.1% for non-Māori and 20% for Māori by 2025. Smoking rates in the Māori population are not projected to reach 5% until 2061.13 Figure 1: Smoking Rate and Estimated Number of Smokers, 2006/07 to 2017/18 670 thousand 20.1% 636 thousand 17.7% 17.4% 16.6% 18.2% 16.3% 623 623 15.7% thousand thousand 14.9% 610 605 thousand 606 thousand thousand 587 Smoking Rate thousand Number of Smokers 2006/07 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Source: Ministry of Health, NZ Health Survey 11Ministry of Health, Health Effects of Smoking, accessed from https://www.health.govt.nz/your-health/healthy-living/addictions/smoking/health-effects-smoking 12Ministry of Health, Health Survey, accessed from https://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/surveys/new-zealand-health-survey 13Office of the Associate Minister of Health, Cabinet Paper, Supporting smokers to switch to significantly less harmful alternatives, 2018 5 Attitudes Towards Tobacco Harm Reduction Products in New Zealand Smoking rates are particularly high in the Māori community, with young Māori women especially affected.