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How 80,000 smokers quit and then relapsed 3 months
later
A case study in tobacco control policy
The intervention. In May 2000, around the time of the first
Budget of the Clark government,
three of the most powerful tobacco control policies impinged on
smokers:
A tobacco tax increase - resulting in
a 20% increase in price, was notified and implemented overnight.
A new set of varied health warnings,
including SMOKING
KILLS appeared on
tobacco packets for the first
time.
Maximum use of the most powerful
television commercial in the Every
cigarette is doing you damage series, the Aorta.
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Results.
- Calls from angry smokers overwhelmed
the toll-free Quitline.
- Some 80,000 smokers quit smoking for at
least 4 months.
- Smoking prevalence was significantly
decreased for the middle 6 months of 2000.1
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Figure
1. Smoking population, any cigarette, New Zealand 2000, quarterly data.
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The error bars show the 95% confidence
interval of the smoking population estimate. (any
type of cigarette).
Source: AC Nielsen and Roy
Morgan Research data combined.
In April to June the smoking
population was significantly less than in the other quarters.
(p<0.001)
In quarters 2 and 3 taken
together, the smoking population was significantly less than for
quarters 1 and 4 combined. (p<0.001)
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Why did conventional tobacco control
measures result in 80,000 smokers becoming quitters, only to relapse?
The effect was temporary,
as after a few months, smokers, with no other source of a nicotine fix,
had to return to smoking if they wanted that nicotine hit again. The
cigarette manufacturers had the monopoly of the nicotine supply.
This large scale
relapse was not unexpected, given that smoking causes a recurrent
relapsing chronic nicotine addiction. However, did they need to relapse
to smoking? Could they have been kept addicted on nicotine?
Government subsidised nicotine patches and gum via the Quitline from late 2000, but these products are not
strong enough for many smokers, and are typically used for weeks rather
than months, so cravings resurfaced and relapses to smoking terminated
this massive achievement in persuading so many smokers to quit.
Conclusion:
- The comprehensive policy, when
coordinated, successfully persuades smokers to quit smoking, but
fails to stop them relapsing.
- If fast-acting nicotine products (pure
nicotine or snuff had been
available at a competitive price in all cigarette shops, in flavours smokers liked, it is likely that many
of the 80,000 would have had their cravings suppressed, and instead
of switching to cheaper RYO cigarettes, would have switched off
smoking for good.
Government
needs a more comprehensive policy to end smoking, one that acknowledges
that
1)
most smokers
are addicted to nicotine, and need a steady supply of it to prevent
relapse to smoking.
2)
many more
smokers (from among the ¾ million who have not yet quit) will avoid fatal
diseases if they can keep their nicotine addiction – but without
smoking.
3)
The price
signals and NZ smokers traditional use of RYOs favour this form of
tobacco use.
Factory made (FM) cigarettes cost $10 a day.
RYO tobacco costs $4 a day. (Tax on RYO tobacco should double before
tax on FM cigarettes is increased.)
Nasal snuff costs $4 a day. (The tax rate should be
reduced 90%)
Nicotine gum, patches and lozenges, 95% subsidized by
government, costing $5 for two weeks supply.
Faster-acting nicotine products are being researched.
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