31 May 2007. NZ SmokeLess
e-News 2:5 World Smokefree
Government bolsters quit
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?
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.
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.
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
New director at ASH
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 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)
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.
2. Broadstock M. Systematic review of the health effects
of modified smokeless tobacco products. NZHTA Report 200710(1). ISBN
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?
situation. Int J Health Equity online 2 November 2006;doi