Tackling ‘place’ and ‘product’ - ASH Scotland. Richard Edwards.pdf · Rezai shi r az et al...
Transcript of Tackling ‘place’ and ‘product’ - ASH Scotland. Richard Edwards.pdf · Rezai shi r az et al...
Tackling ‘place’ and ‘product’
Richard Edwards and Janet Hoek
ASPIRE2025,
University of Otago
Overview
• Tobacco control and place
• Retail/supply
• Smokefree places
• Tobacoc control and product
• Nicotine
• Additives
• [Dissuasive products]
• Current status in NZ
• Conclusion
Introduction
• The 4 Ps of marketing
• Typical focus on ‘promotion’ and ‘price’
• Highly visible elements
• What about ‘place’ and ‘product’?
• Crucial to consider supply and object of consumption
NZ – TC and place: current situation, smokefree
Smokefree indoor workplaces and public places • 1990 most shared offices, public premises, partial in
meal-serving areas • Schools and Early Childhood centres smokefree
(indoor + outdoors) from Jan 2004) • Smokefree inddor hospitality premises from Dec 2004 • Smokefree prisons smokefree (indoor + outdoors)
from June 2011
Smokefree outdoor areas • Smokefree LA policies introduced locally in parks,
playgrounds mainly in recent years
Māori Affairs Select Committee Inquiry
A multi-party inquiry into the tobacco industry and its effects on indigenous people of NZ
• Made several recommendations regarding place and product
• Compulsory reporting of and reductions in additives
• Reducing supply and availability
• Remove POS displays
• Remove industry incentives
• Extend smokefree spaces (particularly those affecting children)
• Establish the smokefree nation goal
Government’s response
“The Committee’s report is clear that “the
term ‘smoke-free’ is intended to
communicate an aspirational goal and not
a commitment to the banning of smoking
altogether by 2025” (p.10). On that basis,
the Government agrees with a longer term
goal of reducing smoking prevalence and
tobacco availability to minimal levels,
thereby making New Zealand essentially a
smoke-free nation by 2025.”
Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori NZ Government, 2011.
NZ – TC and place: current situation retail
Smokefree Environments Amendment Act 2011 • PoS display ban • Restrictions on signage and retail
trading names • Instant fines of up to $1,000 for
sales to minors
But • No registration/ licensing (and no
retailer database) • Very few restrictions on sale of
tobacco (cf. alcohol/ psychoactive substances)
• 5008 tobacco outlets identified (underestimate; industry figure >7000)
• 1 outlet per 617 adults
• 1 outlet per 129 smokers
• 32% of outlets licensed to sell alcohol
Marsh, L., Doscher, C., & Robertson, L. A. (2013). Characteristics of tobacco retailers in New Zealand. Health & Place, 23, 165-170.
Place – tobacco availablity for sale
Place: Distribution of tobacco retail outlets
Marsh et al. Health and Place 2013; 23: 165-170.
Retailers
Tobacco Only
Tobacco and Alchool
Marsh et al. (2013)
Access to tobacco around NZ schools
Place: Youth access
• 46% of secondary schools had 1 or more outlets within 500m walk
• 76% of secondary schools had 1 or more outlets within 1000m walk
• Mean 1.4 outlets within 500m, and 5.7 outlets within 1000m
Possible retail policy approaches
• Emphasis on improving compliance
Mandatory notification/ registration
• Licensing fee, minimum vendor age, staff training stipulations
• Withdrawal of license as sanction
Licensing + minimal
conditions
• opening hours; zoning (schools); no sales with alcohol; sinking lid; restrictions on outlet type; over 18 years shops;
• mandatory stocking of NRT/ quitcard training
Licensing + stronger
conditions 12
Retailer and smoker views
“We’ve stopped smoking in a pub, we’ve stopped smoking on a bus, but we still let cigarettes be retailed in just about every shop in New Zealand. That … seems a paradox.” [NZ smoker]
“If I couldn’t access the cigarettes or the marketing I reckon… that if Helen would take them away, I would be so happy.. Not being able to access them would be the biggest thing.” [NZ smoker]
“My personal view is the sooner that we can stop selling tobacco then the better, … our company has been around for [many] years, and values are pretty important to us, ….we are … doing a disservice to our consumers by advocating tobacco …[and] selling it.” [Senior retailer]
Reducing supply density is possible
• The NZ Psychoactive Substances Act August 1st 2013
• All but one MP supported legislation in Parliament
• Definition of a psychoactive substance:
“ a substance, mixture, preparation, article, device or thing that is capable of inducing a psychoactive effect in an individual who uses the psychoactive substance”
http://www.legislation.govt.nz/act/public/2013/0053/20.0/DLM5042921.html
Radical measures – NOT just a dream?
Retail restrictions on sale of psychoactive substances
• Cannot be sold from dairies, convenience stores, supermarkets, garages
• Cannot be sold from temporary structures or any place alcohol is sold
• Are banned for sale and supply to minors <18 .
• Retailers are required to have a license
• Sellers are to be over 18 yrs
• Local authorities can restrict the location of retailers
https://blogs.otago.ac.nz/pubhealthexpert/2013/09/24/smart-party-pill-law-makes-tobacco-alcohol-regulation-look-pathetic/
Support for retail restrictions
Support highly dependent on smoking status
0
10
20
30
40
50
60
70
80
90
100
No saleswithin 1 kmof a school
Requiringlicences
Restrictingsales to few
outlets
No saleswhere
alcohol issold
'Smokefreegeneration'
Banningtobacco sales
Tobacco aprescription
drug
Daily Smoker (n= 335)
Social Smoker (n= 73)
Former Smoker (n= 160)
Non-smoker (n= 265)
Current and future outdoor smoking policies in NZ, 2013
Marsh L, et al. N Z Med J. 2014; 127:51-66.
Note: Figures weighted by age, ethnicity and socio-economic status. Confidence intervals adjusted for clustering at school level.
Exposure to secondhand smoke (SHS) in vehicles or in the home 2006-12
NZ – TC and product
Attention could also focus on the product itself
• De-nicotinised cigarettes
• Enable smokers to reduce addiction
• Removal of additives
• Decrease the palatability of smoking
• Reduce likelihood of progression from experimentation
• Reduce physical attractiveness of product
• Replace white colour with unappealing colours that evoke negative connotations
Opportunities for product regulation – SF Env Act 1990
• Statement about prohibition and limitation of ‘harmful constituents’
• Could include additives and possibly nicotine
• Act includes specific regulatory powers to prohibit harmful constituents of tobacco products
• Less clear if powers to restrict ‘harmful constituents’
• Clear provision under existing regulatory powers to increase mandatory reporting of product information
• Constituents (testing, returns, reports)
NZ Parliament. Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori. Report of the Māori Affairs Select Committee. Wellington: NZ Parliament, 2010.
MASC and Govt response MASC Reccommendations
• Compulsory for tobacco companies to publicly report the elements of their tobacco and smoke
• Consumers and the MOH will know exactly what substances, and in what proportions, cigarettes and loose tobacco contain
• SFE Act provisions be used to reduce the additives and nicotine in tobacco on an annual basis
Govt response
• ‘Consider’ developing more stringent, specific and effective information disclosure
• Consider promulgating regulations to reduce the harmful constituents in tobacco smoking, including tar and nicotine
De-nicotinised cigarettes
• Five RCTs of denicotinised (<2mg) cigs
• Mixed findings, most modest increase in quit rates
• 3/5 = trials of DNCs as aids in cessation
• Some limitations - small nos, short follow up etc
• Benowitz et al and Walker et al more relevant to impact on population of smokers of mandated DNCs
• Benowitz – smokers not intending to quit, context not a cessation intervention, ? unassisted quits
• Walker – DNCs made available post quit date in community-based context
Denicotinised cigarettes (cont)
• No study of mandated DNCs at population level
• No/little information on:
• Actual impact at population level – initiation, cessation (assisted and unassisted), relapse
• Impacts on assisted cessation with no/ltd availability of ‘regular’ cigs
Removal of additives
• Brazil (2012) proposed banning flavourings in cigarettes including menthol (under challenge)
• Chile proposed ban on menthol in 2013 (not enacted)
Main aim to reduce initiation
• Canadian provinces taking similar steps – Nova Scotia and Alberta 2015, others may follow
• EU Tobacco Products Directive to ban menthol from 2020
Radical measures – just a dream?
NZ Psychoactive Substances Act
Purpose: “… to regulate the availability of psychoactive substances in NZ to protect the health of, and minimise the harm to, individuals who use psychoactive substances..”
• Introduces Expert Advisory Committee and Regulatory Authority
• Approved products: • Should pose no more than a “low risk” of harm to those using it
• New products prohibited on a precautionary basis until regulatory
authority (supported by an expert advisory committee evidence) review is
satisfied that these pose no more than a low risk of harm
Support for product modifications
0
10
20
30
40
50
60
70
80
90
100
Reducing nicotine levels Making cigarettes less pleasant Requiring an unattractivecolour
Daily Smoker (n= 335)
Social Smoker (n= 73)
Former Smoker (n= 160)
Non-smoker (n= 265)
Support for reduced nicotine content
Smokers oppose other measures – but does this mean they would be effective?
Summary
• Tobacco industry knows all about place and product
• Scope to increase focus of tobacco control on place and product,
• Should include focus on radical ‘endgame’ solutions
• Public support already high for many measures
• Evidence limited (but no-one has tried radical measures yet)
Kia ora
Thank you
www.aspire2025.org.nz
Nicotine reduction studies Study Type Keyfindings
Benowitzetal(2012) RCT–(1)Reducingnicotinecontentcigsvs(2)normalbrand
Participants=103smokersnotintendingtoquitatentry
Reducedconsumption,biomarkersofexposureandincreasedthinkingaboutquittingingroup(1)at6months
Hatsukamietal(2010) RCT–(1)0.05mgvs(2)0.3mgvs(3)NRT(Lozenges)
Participants=165‘light’cigsmokerswantingtoquitatentry
Greaterquittingratesamonggroup(1)at3months
Beckeretal(2008) RCT–(1)reducingnicotinecontentcigs+NRT(patch)vs(2)reducingnicotinecontentcigs+(3)placeboNRTvsnormalcigs+NRT
Participants=345smokerswantingtoquitatentry
Greaterquitratesat4weeksforgroup(1).Nodifferencesat3and6months,butsubstantialdropout->smallnumbers.
Rezaishirazetal(2007)
RCT–(1)pre-quit0.05mgcigs+NRT(patches)postquitvs(2)prequit0.6mgcigs+postquitNRT
Participants=98heavysmokers
Nosigdifferenceinquittingat6months.Reducedcravingingroup(1).
Walkeretal(2012) RCT–(1)0.05mgcigs+Quitlinecare(incNRT)vs(2)Quitlinecare
Participants=1408NZQuitlinecallers
Smallincrease(RR1.18/1.50)inquitratesat6monthsingroup1