Review of Tobacco Control Services SHORE & Whariki Research Centre College of Health, Massey University P O Box 6137, Wellesley St, Auckland July, 2014 Acknowledgments We are grateful for the assistance given and provision of information and data for this report from the Ministry of Health, District Health Boards and participants in the consultation activities. Other researchers from Massey University and others from the tobacco control and public health sectors provided valuable advice and guidance to the research team. This report was prepared by Sally Casswell, Martin Wall, Judy Lin, and Jeffery Adams, SHORE & Whariki Research Centre, College of Health, Massey University. The advisors to the project (Richard Edwards, Anaru Waa, Heather Gifford, Jan Pearson, Warren Lindberg, Hayden McRobbie, Paul McDonald, Helen Moewaka Barnes, Lanuola Asiasiga and Angela Moewaka Barnes) provided very valuable input to the project but the final responsibility for the report remains that of the authors. Table of contents 2 | Page Table of Contents Review of Tobacco Control Services ....................................................................................................... 1 Acknowledgments ........................................................................................................................... 2 List of Tables .................................................................................................................................... 5 Executive Summary ................................................................................................................................. 6 Introduction .......................................................................................................................................... 34 Evidence of effective approaches to tobacco control .......................................................................... 37 Introduction .................................................................................................................................. 37 Summary of results ....................................................................................................................... 40 Types of intervention .................................................................................................................... 47 Service delivery models for prevention ........................................................................................ 52 Service Delivery Models for Cessation .......................................................................................... 56 Cost effectiveness ......................................................................................................................... 71 Second hand smoke and denormalisation .................................................................................... 73 Social Marketing and mass media campaigns .............................................................................. 74 Gaps in the Evidence ..................................................................................................................... 76 Conclusions ................................................................................................................................... 77 Map of Tobacco Control Services ......................................................................................................... 78 Introduction .................................................................................................................................. 78 Methods ........................................................................................................................................ 81 Smoking Cessation Services funded by the Ministry of Health ..................................................... 82 Cessation sector development and collaboration ...................................................................... 133 Health Promotion and Advocacy................................................................................................. 135 Enforcement ................................................................................................................................ 144 Leadership and coordination ...................................................................................................... 147 Research and building knowledge .............................................................................................. 156 Gaps and Opportunities ...................................................................................................................... 162 The current situation in New Zealand: data from the 2013 Census ........................................... 162 Projected impact of assisted quits .............................................................................................. 172 Smokefree Environment in New Zealand ................................................................................... 175 Messaging about preventing uptake and encouraging quitting ................................................. 178 Engagement beyond the health sector ....................................................................................... 180 Enhancing incentives and structures to encourage collaboration across the health sector ...... 182 Table of contents 3 | Page Assisted smoking cessation services ........................................................................................... 182 Reporting on assisted quitting .................................................................................................... 186 Supply and distribution of pharmacological interventions ......................................................... 186 Building the capacity and capability of the sector (organisational, infrastructure, workforce) . 187 Pathway to Smokefree New Zealand 2025 Innovation Fund and Research ............................... 188 Allocation of funds and accountabilities ..................................................................................... 188 Recommendations .............................................................................................................................. 190 References .......................................................................................................................................... 197 Appendix: Consultation with tobacco control sector ......................................................................... 209 Table of contents 4 | Page List of Tables Table 1: Summary of results ................................................................................................................. 40 Table 2: Summary of cost-effectiveness of brief interventions ............................................................ 72 Table 3: MOH DHB contracts 2013/14 .................................................................................................. 79 Table 4: Quitline contracts with the MoH ............................................................................................ 83 Table 5: Quitline Registrations by priority groups: July 2012-June 2013 ............................................. 84 Table 6: AKP providers .......................................................................................................................... 86 Table 7: AKP Providers by Region ......................................................................................................... 90 Table 8: Services for pregnant women who smoke .............................................................................. 94 Table 9: Cessation services and support provided by DHB (from reports) ........................................... 95 Table 10: Counties Manukau DHB smokefree service ........................................................................ 106 Table 12: Waitemata DHB AKP providers 2012-13 year ..................................................................... 109 Table 13: AKP providers Waikato DHB ................................................................................................ 111 Table 14: Southern DHB: Maori Health providers .............................................................................. 114 Table 15: Whanganui DHB: Quit clinic ................................................................................................ 126 Table 16: Health promotion and advocacy undertaken by DHB ........................................................ 137 Table 17: Controlled Purchase Operations (CPOs) carried out by Public health Units: Jul-Dec 2013 144 Table 18: Enforcement reported by DHB ............................................................................................ 145 Table 19: Leadership activities provided by DHB................................................................................ 149 Table 20: Research and innovation undertaken by DHB .................................................................... 159 Table 21: Overall smoking prevalence ................................................................................................ 163 Table 22: Numbers and prevalence: 15-19 year olds ......................................................................... 164 Table 23: Numbers and prevalence: 20-24 year olds ......................................................................... 165 Table 24: Smoking number and prevalence (ordered by number of European smokers) ................. 166 Table 25: Smoking number and prevalence (ordered