Darren Walton, Rhiannon Newcombe, Judy Li, Jo White ......•Wanted to quit smoking completely – 31% •Wanted to replace cigarettes smoking some of the time – 8% •Among current

Research updates from

HPA

Darren Walton, Rhiannon Newcombe, Judy Li,

Jo White & Hayley Guiney

HPA Research & Evaluation

Range of work – helping to build an

evidence base

• National population monitors

• NZ Health & Lifestyles Survey (HLS)

• NZ Youth Tobacco Monitor (YIS, ASH snapshot)

• NZ Smoking Monitor (‘Continuous Monitor’)

• Formative research

• Impact evaluation

What we’ll cover today

1. E-cigarette use

2. Attitudes to tobacco regulation

3. Hardening hypothesis

4. Co-morbid use of tobacco with other substances

5. Tobacco Control Data Repository

Electronic cigarettes

HPA started monitoring use and attitudes from 2011

Today’s presentation:

• 2014 – population-based survey data

• Youth

• Adults

• Future studies

E-cigarette use among 14 & 15-

year-olds

Rate of ever-use is rapidly increasing

2014: 20%

2012: 7% Main reasons for first trying 1. Curiosity (65%) 2. Recommended by

another person (24%) 3. Safer than tobacco

cigarettes (20%)

NOT cessation

64.7

53.8

41.2

16.5

6.1

0

10

20

30

40

50

60

70

Current smokers Infrequent smokers

Ex-smokers Susceptible never-smokers

Non-susceptible never-smokers

E-cigarette use among adults

in 2014 • Ever-use = 13%

• Current use = 1%

• Differed by tobacco smoking status

49.9

8.4 3.4 4

0.1 0.1 0

10

20

30

40

50

60

Current smokers Ex-smokers Never-smokers

Ever-use (%) Current use (%)

Adults: Reasons for first trying

an e-cigarette • Among all ever-users

• Curiosity – 57%

• Wanted to quit smoking completely – 31%

• Wanted to replace cigarettes smoking some of the time – 8%

• Among current e-cig users (*n=31)

• Wanted to quit smoking completely – 51%

• Wanted to replace cigarettes smoking some of the time – 22%

• Curiosity – 15%

• Used as a substitute in places where smoking is prohibited – 10%

Current project on e-cigarettes

Longitudinal data • Recruited from the New Zealand Smoking Monitor

• In field 2013 & 2014

• Follow-up rate = 67% (139/209 respondents)

Analyses in progress • Predictors for subsequent use of e-cigarettes

• Changes in rates of exposure to e-cigarette advertising

and e-cigarette use in general

• Context around first trying an e-cigarette

Attitudes to tobacco regulation

Attitudes to tobacco regulation

• Where are the public at?

• Helpful to understand their views

• Looked at change over time and latest findings

• Preliminary data

0

20

40

60

80

100

All outdoor transport waiting areas

All main outdoor shopping areas of a town

Within 5 metres of the entrance of all buildings used

by the public

All public outdoor dining areas

Proportion of respondents supporting banning smoking at ...

Current smokers

Ex-smokers

Never smokers

0

20

40

60

80

100

Disallowing cigarettes to be sent in New Zealand by post, courier or other mean

Banning sale at Dutyfree shops

Proportion of respondents supporting reducing the accessibility of cigarettes and tobacco by...

Current smokers

Ex-smokers

Never smokers

0

20

40

60

80

100

Ban smoking in all outdoor public places where children

are likely to go

Tobacco display ban Reduce the number of retail outlets that sell cigarettes

Do not allow cigarettes to be sold in 10 years’ time

Proportion of respondents supporting the following regulations ...

2008

2010

2012

2014

Hardening hypothesis

Hardening hypothesis

As prevalence of smoking reduces, remaining smokers are increasingly ‘hardcore’ or hardened

Therefore, progress to reduce smoking prevalence slows

Importance: implications of hardening Y/N

• Y – need to consider better targeting and increased intensity of

cessation support, targeted policy/environmental interventions; support for harm minimisation approaches

• N - continue with current approaches; doesn’t support need for harm minimisation approaches (on grounds of hardening)

Measures

Facet Manifestation in smoking population

Examples of possible measures

Current study

Attitudes to smoking and quitting

Decreasing desire/motivation to quit Low and decreasing support for tobacco control measures and goals

Quit intentions Attitudes to smoking/tobacco control

- % smokers no quit attempts in last year - Attitudes to smokefree 2025

Degree of addiction

Increasing level of addiction and intensity of smoking

Fagerstrom score Nos smoked/day

- Daily/current smokers - % smokers > 4 quit attempts in last year

Demographics and health

Smokers increasingly concentrated among disadvantaged groups

SES measures, co-morbidities

- SES of smokers

Quit outcomes Reducing population level quit rates

Quit success rates - % smokers quitting in last year/2 years

Results

Preliminary analysis

Quit outcomes • Suggestion of increasing quit rate

• Smokers making multiple recent quit attempts

• Positive sign – not a sign of hardening

Comorbidity

Young people engage in

multiple risky behaviours

Year 10 students who had smoked tobacco in the past month...

%

TOTAL 11.4

Young people engage in

multiple risky behaviours

Year 10 students who had smoked tobacco in the past month...

%

TOTAL 11.4

Tobacco only 2.6

Tobacco + marijuana 1.4

Tobacco + binge drinking 2.2

Tobacco + marijuana + binge drinking 4.7

Update on the Tobacco Control

Data Repository

Landing page

• Health and Lifestyles Survey (HLS)

• New Zealand Cancer Registry (NZCR) and Mortality Collection (MORT)

• New Zealand Census • New Zealand Health Survey

(NZHS) • New Zealand Smoking

Monitor (NZSM) • Quitline data • Sales data • Smoking Cessation Services

(MoH) • Year 10 Snapshot (ASH) • Youth Insights Survey (YIS)

TCDR – Data sources

HLS – Ever smoked tobacco

Cancer Registration and Mortality

Health Survey (MoH)

Census – Changes over time, by demographics and DHB

Title

Sub heading. To get to next level of text

press ‘enter’ and ‘tab’

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next level of text press ‘enter’ and ‘tab’

• First bullet

• Second bullet

• Third bullet

2006, 2013 Census

cigarette smoking

behaviour map at

District Health Board,

Census Area Unit and

Meshblock level (GIS)

URL: http://www.tcdata.org.nz/Censu

s%20data/Census_14.aspx

(Source: NZ Census 2006 and 2013,

Statistics NZ)

Statistical standard for cigarette

smoking behaviour

Research updates from

HPA

[email protected]

[email protected]

What predicts e-cigarette use?

• Analysis restricted to NEVER-USERS in 2013 (n=95)

• 20% had become an ever-user in 2014

• Included in stats model:

• Socio-demo (gender, ethnicity, age, household income, education)

• Smoking-related (recent quit attempts, time of first cigarette, intention to quit)

• Exposure (exposure to e-cig ad, exposure to e-cig use)

• Attitudes (attitudes towards banning e-cig use in hospitality settings, perceived functions of e-cig in tob control)

What predicts e-cigarette use?

• Recent exposure to e-cigarette use (reported in 2013)

• gender, ethnicity, age, household income, education, recent

quit attempts, time of first cigarette, intention to quit, exposure

to e-cig ad, exposure to e-cig use, attitudes towards banning

e-cig use in hospitality settings, perceived functions of e-cig in

tob control