31 May 2007. NZ SmokeLess e-News 2:5  World Smokefree Day

Government bolsters quit smoking efforts


Government has tagged $43.6 million over four years to boost stop smoking efforts. The total sum now spent on tobacco control, at $41 million annually or $10 per man woman and child, equal to the cost of a packet of 20 cigarettes, may be one of the highest allocations per capita in the world, so the question is, how will it be spent?


Hon Damien O’Connor Associate Health Minister, says tobacco is one of nine health sector target areas agreed by the Ministry of Health and District Health Boards. This funding is new money, in addition to the $30 million being spent annually since about 2000.


Damien O’Connor told SmokeLess that for some drugs such as tobacco, his personal experience was that abstinence was the best policy. He said that as Australia was getting better results with quitting, we should look at what they were doing right in Australia. He was disappointed that tobacco tax was not increased in the Budget.


The Government’s announced primary care initiatives are aimed at increasing the number of quit attempts. The upcoming cessation guidelines and training for cessation practitioners is part of this.


Ministry of Health will increase its spend of $2.5 million (of its own money) annually subsidizing patches and gum, to increase the number quitting with the help of subsidized NRT. The Quitline will be boosted, and also pregnancy services, a media campaign to usher in the new cigarette packet warnings, and mental health services, to reduce the high smoking rates seen in the mentally ill.


Computer modeling backs Government funding emphasis on quit attempts


The Public Health Intelligence Unit of the Ministry of Health has used the findings of the recent tobacco use survey to model and compare the policy effect of making more quit attempts versus making each quit attempt successful.

As only 40% of smokers had made a quit attempt in the past year, and because only a fifth of quit attempts were aided by NRT, there is plenty of scope for emphasizing both. Knowing that NRT aided attempts have twice the success rate, a little arithmetic shows that increasing quit attempts as a policy is five times more important than getting every quit attempt aided by NRT.


What increases quit attempts?

1) Government money as promised above, to fund media campaigns, etc. etc.

2) Increases in the price of cigarettes. (particularly RYOs)

3) The placebo effect (enthusiasm, new flavours, new nicotine products, placebo products, enrolling those interested in cutting down), could all increase quit attempts. A certain percentage of people quit if they only try, and practice at quitting may be important for success.

4) Advertising linking products (Nicorette, Quitline) with modelling of behaviour to take the first step.

5) Availability of snuff to make switching possible without having to quit tobacco altogether.


New director at ASH

Congratulations and welcome to Ben Youdan, new director of ASH NZ and formerly director of the UK No-smoking Day. Ben took up his post earlier this month.


Low nitrosamine snuff can improve population health -The Lancet


The Lancet carried three articles about (Swedish moist oral) snuff earlier this month. A fourth, in the International. Journal of Health Equity documents and discusses how to reduce social and ethnic health inequity in New Zealand.


1. Low nitrosamine snuff can improve population health A University of Queensland study, modeling health effects of cigarettes versus snuff has found that snuff would improve population health, provided that sufficient inveterate smokers switched to it. The analysis showed that smokers switching to snuff had almost as long a healthy life expectancy as those quitting entirely. (1)


2. Low nitrosamine snuff is much less dangerous than smoking (though not without some risk). As a recent NZ review found, snuffing is much less dangerous than smoking.(2) Now the Lancet has published a large study of Swedish construction workers showing that Swedish snuff (snus) is much less dangerous than smoking as, it did not cause lung or mouth cancer as smoking did.

Smoking also caused pancreatic cancer in these men, and snuff caused it at a lesser rate, but at double the rate on never-tobacco users.(3) This study did not control for alcohol, a known cause of pancreatic cancer.


3. Continuation of bans on snuff is bad public policy A third piece in the Lancet, commenting on the results, by two US professors (Kozlowski and Foulds) said that in cigarette-rife economies, the continued ban on snuff, or exaggerated opposition to it, was bad public policy, and snuff should be allowed to compete with cigarettes for market share.(4)


4. Can reduce health inequity Wellington Clinical School researchers have highlighted the scope for reducing health inequities in New Zealand, if tobacco users can be shifted away from smoking to nicotine or smokeless products. (5)


1 Gartner CE, Hall WD, Vos T, et al. Assessment of Swedish snus for tobacco harm reduction: and epidemiological modeling study. Lancet online May 10, 2007. doi:10.1016/S0140-6736(07)60677-1

2. Broadstock M. Systematic review of the health effects of modified smokeless tobacco products. NZHTA Report 200710(1). ISBN 978-1-877455-00-1.

3 Luo J, Ye W, Zendehdel K, et al.Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet May 10, 2007. DOI:10.1016/S0140-6736(07)60678-3

4 Foulds J. Kozlowski L. Snus- what should the public health response be? Lancet online May 10, 2007. doi:10.1016/S0140-6736(07)60679-5

5. Wilson N, Blakely T, Tobias M. What potential has tobacco control for reducing health inequalities? The New Zealand situation. Int J Health Equity online 2 November 2006;doi 10.1186/1475-9276-5-14.

 Dr Murray Laugesen QSO chair; Prof Ross McCormick, Sir John Scott KBE, Trish Fraser MPH, Dr Marewa Glover, Trustees

Making it easier to quit smoking for good 2009 End Smoking NZ