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Background: There is limited evidence available on the nature of children's exposure to smoking and smoking paraphernalia in private spaces (homes and cars). We aimed to evaluate the extent and nature of children's exposure to smoking in these settings using image data captured by wearable cameras., Methods: One-hundred and sixty-eight children wore wearable cameras for 4 days that automatically took pictures every 7 s. Images captured in private spaces (n = 140,818) by children living in households with a smoker (n = 34) were screened for instances of smoking and smoking paraphernalia., Results: A total of 37 incidents of smoking-four indoor, 21 outdoor, and two in-vehicles-and 62 incidents of smoking paraphernalia were observed. Most smoking incidents in homes (21 of 33) took place outdoors., Conclusions: The findings support health promotion efforts to make smokers more aware that smoking paraphernalia may normalize smoking for children. The methodology (wearable cameras) appears to have high utility for studying health behaviours in private spaces., (© 2018 John Wiley & Sons Ltd.)

Background: Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree outdoor spaces reduce secondhand smoke exposure and de-normalize smoking., Methods: After previously publishing a study of smokefree indoor and outdoor space policies, it was brought to the authors' attention that the dataset used in analyses was incomplete (Lowrie et al., BMC Public Health 17:456, 2017). The current manuscript is a corrected version. Here, we include analyses for outdoor space policies. We evaluated regional and demographic differences in the proportion of the population (both adult and child) covered by smokefree outdoor space policies for school grounds and playgrounds enacted in the United States prior to 2014., Results: Children had a low level of protection in playgrounds and schools (8% covered nationwide in both settings). Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). The odds of having a smokefree playgrounds policy was lower for jurisdictions with higher proportions of poor households, households with no high school diploma, whites and the Alaska/Hawaii region. Increased ethnic heterogeneity was found to be a significant predictor of increased odds of having a smokefree playgrounds policy, meaning that diversity is protective, with differential effect by region (p < 0.001) - which may relate to urbanicity., Conclusions: Disparities in smokefree outdoor space policies have potential to exacerbate existing health inequities. A national increase in smokefree outdoor space policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.

Background: Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree indoor and outdoor spaces reduce secondhand smoke exposure and denormalize smoking., Methods: We evaluated regional and demographic differences in the proportion of the population covered by smokefree policies enacted in the United States prior to 2014, for both adults and children., Results: Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). Smokefree policy coverage was lower for jurisdictions with higher proportions of poor households, households with no high school diploma and the Southeast region. Increased ethnic heterogeneity was found to be a significant predictor of coverage in indoor "public spaces generally", meaning that diversity is protective, with differential effect by region (p = 0.004) - which may relate to urbanicity. Children had a low level of protection in playgrounds and schools (~10% covered nationwide) - these spaces were found to be covered at lower rates than indoor spaces., Conclusions: Disparities in smokefree space policies have potential to exacerbate existing health inequities. A national increase in smokefree policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.

Aim: To design new tobacco control legislation to achieve the New Zealand Government's 2025 smokefree goal., Method: An original analysis of the legislative options for New Zealand tobacco control., Results: 'Business as usual' is most unlikely to achieve smoking prevalence that is less than 5% by 2025. Key components of a new Act would ideally include plans and targets with teeth, a focus on the industry, a focus on the product, reduction of supply, and a whole-of-society approach to promote consistency in policy implementation through: i) a public duty on government agencies to act consistently with smokefree law; ii) a general duty on those associated with the tobacco/nicotine industry in relation to tobacco control objectives; and iii) a principle requiring international treaties to be interpreted consistently with tobacco control objectives., Conclusion: Strategies such as those identified in this Viewpoint should be explored further as part of urgently needed planning to achieve the New Zealand Government's goal for Smokefree Aotearoa by 2025.

Health behavior takes place within social contexts. In this study, we investigated whether changes in exposure to neighborhood deprivation and smoking prevalence and to household smoking were associated with change in personal smoking behavior. Three waves of biannual data collection (2004-2009) in a New Zealand longitudinal study, the Survey of Family, Income and Employment (SoFIE)-Health, were used, with 13,815 adults (persons aged ≥15 years) contributing to the analyses. Smoking status was dichotomized as current smoking versus never/ex-smoking. Fixed-effects regression analyses removed time-invariant confounding and adjusted for time-varying covariates (neighborhood smoking prevalence and deprivation, household smoking, labor force status, income, household tenure, and family status). A between-wave decile increase in neighborhood deprivation was significantly associated with increased odds of smoking (odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.02, 1.14), but a between-wave increase in neighborhood smoking prevalence was not (OR = 1.04, 95% CI: 0.98, 1.10). Changing household exposures between waves to live with another smoker (compared with a nonsmoker (referent)) increased the odds of smoking (OR = 2.48, 95% CI: 1.84, 3.34), as did changing to living in a sole-adult household (OR = 1.52, 95% CI: 1.07, 2.14). Tobacco control policies and programs should address the broader household and neighborhood circumstances within which individual smoking takes place., (© The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To extend the limited international evidence on youth in-vehicle second-hand smoke (SHS) exposure by examining trends in New Zealand, a country with a national smoke-free goal and indoors smoke-free environment legislation., Methods: We tracked exposure rates and explored the associations between in-vehicle SHS exposure and smoking behaviours. In-home exposure was also examined for comparative purposes. Data were collected in annual surveys of over 25 000 year 10 school students (14-15-year olds) for a 7-year period (2006-2012). Questions covered smoking behaviour, exposure to smoking and demographics., Results: Youth SHS exposure rates in-vehicle and in-home trended down slightly over time (p<0.0001 for both) with 23% exposed in-vehicle in the previous week in 2012. However, marked inequalities in exposure between ethnic groups, and by school-based socioeconomic position, persisted. The strongest association with SHS exposure was parental smoking (eg, for both parents versus neither smoking in 2012: in-vehicle SHS exposure adjusted OR: 7.4; 95% CI: 6.5 to 8.4). After adjusting for seven other factors associated with initiation, logistic regression analyses revealed statistically significant associations of in-vehicle SHS exposure with susceptibility to initiation and smoking., Conclusions: The slow decline in SHS exposure in vehicles and the lack of progress in reducing relative inequalities is problematic. To accelerate progress, the New Zealand Government could follow the example of other jurisdictions and prohibit smoking in cars carrying children. Other major policy interventions, beside enhanced smoke-free environments, will also likely be required if New Zealand is to achieve its 2025 smoke-free nation goal., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Aim: To collect data on tobacco brand visibility on packaging on outdoor tables at bars/cafes in a downtown area, prior to a proposed plain packaging law., Method: The study was conducted in the Central Business District of Wellington City in March 2014. Observational data were systematically collected on tobacco packaging visibility and smoking by patrons at 55 bars/cafes with outdoor tables., Results: A total of 19,189 patrons, 1707 tobacco packs and 1357 active smokers were observed. One tobacco pack was visible per 11.0 patrons and the active smoking prevalence was 7.1% (95%CI: 4.9-9.2%), similar to Australian results (8.3%). Eighty percent of packs were positioned face-up (showing the brand), 8% face-down (showing the large pictorial warning), and 12% in other positions. Pack visibility per patron was significantly greater in areas without child patrons (RR=3.1, p<0.0001). Both smoking and pack visibility tended to increase from noon into the evenings on weekends. Inter-observer reliability for key measures in this study was high (Bland-Altman plots)., Conclusion: Tobacco branding on packaging was frequently visible because of the way smokers position their packs. These results highlight the residual problem posed by this form of marketing. The results also provide baseline data for the future evaluation of plain packaging if a proposed law is implemented in New Zealand. Other results warrant further research, particularly the reasons for lower pack visibility and smoking when children were present.

Introduction: We aimed to describe long-term trends in smoking in vehicles in a deprived local community in the Wellington region of New Zealand, and to consider the impact of a local community-initiated smokefree vehicle campaign., Methods: An observational study in 2013 of smoking in vehicles repeated the methods of two previous studies (conducted in 2005 and 2011) in the same location (Wainuiomata) in New Zealand. The 2013 study followed a local smokefree vehicle campaign which began in early 2013., Results: Data were systematically collected on 57,672 vehicles in 2013. The point prevalence of smoking in vehicles decreased from 6.4% (95% CI: 5.9%-7.1%) in 2005 to 4.9% in 2011 (95% CI: 4.8%-5.1%) to 3.4% in 2013 (95% CI: 3.2%-3.5%). For vehicles with others (adults and children) there was a reduction from 1.4% in 2005 to 1.1% in 2011 and to 0.7% in 2013. In vehicles with children, the decline was from 0.22% in 2011 to 0.10% in 2013 (p<0.001 for all 2011-13 comparisons). Smoking in vehicles with other people present declined three times faster during 2011-13 than during 2005-2011., Conclusions: In the context of relatively slow change in national trends for smoking prevalence and for smoking in cars, the results appear to be consistent with the local campaign having some beneficial impact on smoking behaviour in vehicles. However, achieving fully smokefree vehicles, and the consequent health equity dividend, will probably require national-level smokefree vehicle legislation.

Background: The influence of visual exposure to health-related behaviours, such as smoking, is increasingly acknowledged in the public health literature. Social contagion or normalisation is thought to operate through the visibility of those behaviours. There has been a lack of systematic and comprehensive approaches to quantifying visual exposure to these behaviours over a relatively large geographic area. We describe the novel application of a geographic tool, viewshed analysis, to estimate visual exposure to smoking outside bars/cafés across a downtown area., Methods: Smoking was observed for different times and days of the week at 14 outdoor areas of bars/cafés throughout downtown Wellington, New Zealand. We used these data to extrapolate to other bars/cafés with outdoor seating. We then conducted viewshed analyses to estimate visual exposure to smoking at bars/cafés for all public outdoor spaces., Results: We observed a smoking point prevalence of 16%. Visibility analyses indicated that estimated visible smoking was highest in the evenings (7-8 pm), where the average values across Wednesday and Friday ranged from zero up to 92 visible smokers (mean=1.44). Estimated visible smoking at midday ranged from zero to 13 (mean=0.27). Values were also higher at the end of the week compared with midweek in the evening. Maps indicate that streets with high levels of retail shops and hospitality areas had high values of estimated visible smokers, particularly in the evening where numbers were consistently above 50., Conclusions: This paper highlights a useful method for measuring the extent of visual exposure to smoking behaviours across relatively large areas using a geospatial approach. Applying this method in other locations would require consideration of place-specific characteristics which impact on visibility and could be improved through more sophisticated extrapolation of observational data across the study area. The findings of this and similar research could ultimately support the expansion of smokefree public spaces.

Background: We have developed manual methods to gather data on the point prevalence of observed smoking in road vehicles. To enable the widespread international collection of such data, we aimed to develop a smartphone application (app) for this work., Methods: We developed specifications for an app that described the: (1) variables that could be collected; (2) transfer of data to an online repository; (3) user interface (including visual schematics) and (4) processes to ensure the data authenticity from distant observers. The app functionality was trialled in roadside situations and the app was made publicly available., Results: The smartphone app and its accompanying website were developed, tested and released over a period of 6 months. Users (n=18) who have registered themselves (and who met authentication criteria), have reported no significant problems with this application to date (observing 20 535 vehicles as of 5 July 2012). The framework, methodology and source code for this project are now freely available online and can be easily adapted for other research purposes. The prevalence of smoking in vehicles was observed in: Poland 2.7% (95% CI 2.3% to 3.1%); Australia 1.0% (95% CI 0.7% to 1.3%); New Zealand 2.9% (95% CI 2.6% to 3.2%)-similar to results using preapp methods in 2011 (3.2%, 95% CI 3.1% to 3.3%)., Conclusions: This project indicates that it can be practical and feasible for health researchers to work together with information science researchers and software developers to create smartphone apps for field research in public health. Such apps may be used to collect observational data more widely, effectively and easily than through traditional (non-electronic) methods.

Introduction: To advance the design and implementation of outdoor smokefree area policies, we aimed to develop simple, low-cost methods for measuring smoking in a variety of public places., Methods: Two methods were developed and were used by solo observers during March 2011-February 2012 to measure the proportion of people smoking at a variety of sites., Results: Both methods performed well (n=5553 people observed); the first at 58 sites in the UK and New Zealand (n=3191 observed); the second at 33 sites in New Zealand (n=2362 observed), with significant differences found between the smoking at types of sites and between countries. For the two countries combined, the proportions of people smoking (amongst those over 12 years) in children's play areas was significantly lower compared to all the other sites combined (risk ratio=0.39; 95%CI: 0.20 to 0.76; p=0.002)., Conclusions: Solo observers can establish the proportion of people smoking in a range of outdoor sites. Such methods can inform outdoor smokefree area policymaking by providing baseline and post-policy data to enable location targeting and policy evaluation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: The objective is to (a) refine and use methods to measure the point prevalence of smoking and of secondhand smoke exposure in moving vehicles and (b) compare these prevalences (1) between two areas of contrasting socioeconomic status and (2) over time., Methods: The authors developed and tested a single-observer method and observed the point prevalence of smoking in vehicles in Wellington, New Zealand. The two observation sites represented high and low areas of socioeconomic deprivation (based on a small area deprivation index)., Results: A total of 149 886 vehicles were observed. The mean point prevalence of smoking in vehicles at both sites combined was 3.2% (95% CI 3.1% to 3.3%). Of those vehicles with smoking, 4.1% had children present. Smoking point prevalence in vehicles was 3.9 times higher in the area of high deprivation than in the area of low deprivation (95% CI 3.6 to 4.2). The same pattern was seen for vehicles with only the driver at 3.6 times (95% CI 3.4 to 4.0), in vehicles with other adults at 4.0 times (95% CI 3.4 to 4.7) and in vehicles with children at 10.9 times (95% CI 6.8 to 21.3), with all results adjusted for vehicle occupancy., Conclusions: Observing smoking in vehicles using a single-observer method provides a feasible and objective indicator of the different smoking behaviours, especially around children, within an area. This study further supports the evidence from this country and internationally that adults and children from high-deprivation areas are much more likely to be exposed to secondhand smoke.

Objectives: Denormalizing campaigns reframe smoking as an unappealing behavior, more likely to lead to social exclusion than inclusion. Social identity theory suggests this strategy will reinforce smoke-free norms and, as these become mainstream, decrease smoking prevalence. However, little is known about how these campaigns affect perceptions of smoking among young adult smokers and nonsmokers, or behavior toward smokers. A qualitative study was conducted to a) explore how smokers and smoking were perceived in an environment where smoking has become an increasingly unacceptable social behavior and b) examine whether and how this environment stigmatized smokers., Methods: About 14 group discussions and 4 in-depth interviews involving 86 participants, aged between 18 and 24 and of Māori, Pacific, and NZ European ethnicities, were conducted as part of a wider study examining young adults' responses to tobacco branding and plain packaging., Results: The themes identified illustrated how nonsmokers' perception of smoking as illogical and self-destructive supported harsh reactions, including stigmatizing behaviors that antagonized smokers. Nonsmokers, who recognized smoking's addictiveness, were more empathic and less judgmental of smokers., Conclusion: Including empathic content in smoking denormalizing campaigns may reduce judgmental reactions that inadvertently create a gulf between status of young adult smokers and nonsmokers. A supportive/empathic tobacco-control denormalization approach could enhance young adult smokers' willingness to make the transition from smoker to smoke free and elicit stronger support for their efforts from nonsmokers.

Objective: To investigate the attitudes of business people toward a possible smokefree policy along a route of major shopping streets, the "Golden Mile" (GM) in central Wellington, New Zealand., Methods: Businesses on the GM (n = 303) were visited in June-July 2011. Either the owner or manager from each business was surveyed., Results: A response rate of 65.6% (n = 198) was achieved, with 13.3% declining to participate, and further contact not being productive for 21.2%. Support for making the GM smokefree was 43.4% (95% CI = 36.7%-50.4%), with the remainder opposed. There was significantly higher support among business people who were nonsmokers versus smokers (relative risk = 2.95; 95% CI = 1.48-5.89). Overall, 83.3% (95% CI = 77.0%-88.0%) of respondents stated that a smokefree GM would have either a positive or negligible impact on their business (nonconcern), compared with a negative impact (at 16.7%). Nonconcern about the business impact of a smokefree GM was significantly greater for nonfood businesses (89.9%) versus food businesses (64.0%; p < .001), after adjusting for respondent age, smoking status, and gender in logistic regression models., Conclusions: The modest support for introducing a smokefree streets policy by GM business people may reflect the negligible promotion of the idea in this setting. Nevertheless, the likely business impact of a smokefree streets policy was not a concern for the large majority of these business people, so this may not be a significant barrier to policy development. This type of study can contribute to the process for developing smokefree streets and other outdoor areas, by gauging sector support.

Background: There is increasing interest in ending the tobacco epidemic and in applying 'endgame' solutions to achieve that goal at national levels. We explored the understanding of, and reactions to, a tobacco-free vision and an endgame approach to tobacco control among New Zealand smokers and non-smokers., Methods: We recruited participants in four focus groups held in June 2009: Māori (indigenous people) smokers (n=7); non-Māori smokers (n=6); Māori non-smokers (n=7); and non-Māori non-smokers (n=4). Participants were from the city of Whanganui, New Zealand. We introduced to them the vision of a tobacco-free New Zealand and the concept of a semi-autonomous agency (Tobacco-Free Commission [TFC]) that would control the tobacco market as part of an endgame approach., Results: There was mostly strong support for the tobacco-free New Zealand vision among all groups of participants. The reason most commonly given for supporting the vision was to protect children from tobacco. Most participants stated that they understood the TFC concept and reacted positively to it. Nevertheless, rather than focusing on organisational or structural arrangements, participants tended to focus on supporting the specific measures which a future TFC might facilitate such as plain packaging of tobacco products. Various concerns were also raised around the TFC, particularly around the feasibility of its establishment., Conclusions: We were able to successfully communicate a complex and novel supply-side focused tobacco control policy intervention to smokers and non-smokers. The findings add to the evidence from national surveys that there is public support, including from smokers, for achieving a tobacco-free vision and using regulatory and policy measures to achieve it. Support for such measures may be enhanced if they are clearly communicated and explained with a rationale which stresses protecting children and future generations from tobacco smoking.

Introduction: To address the paucity of research around smokefree streets, we: (i) refined existing data collection methods; (ii) expanded on the meagre previous research in this area; and (iii) compared results by differing size of urban centre., Methods: We refined established methods; a solo observer simultaneously observed smoking and measured fine particulate levels (PM(2.5)) on a route of shopping streets in central Lower Hutt City, New Zealand., Results: Over 33.6 h of measurement, mean fine particulate levels were 1.7 times higher when smoking was observed than when it was not (7.9 vs 4.8 μg/m(3); p=0.0001)., Conclusions: Smoking appeared to be a substantive contributor to fine particulate air pollution in city streets, when compared to levels adjacent to road traffic., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Tobacco companies have opposed the removal of tobacco retail displays, arguing this would compromise retailers' safety, increase retail crime, reduce retailers' income, impose additional costs and be inconvenient. These arguments have successfully delayed policy development in several jurisdictions., Methods: In-depth interviews conducted with New Zealand retailers who had voluntarily removed tobacco from open display in their stores., Results: Retailers who had removed tobacco displays did so primarily to reduce their security risk and found their stores had become less vulnerable to retail crime. They did not find removing displays costly or inconvenient nor had this decision significantly reduced their revenue., Conclusions: Removing in-store tobacco displays may increase rather than decrease store safety. Our findings reveal that retailers' experiences differed in many ways from tobacco companies' predictions and suggest that industry arguments against display removal lack objective support and are self-serving.

Introduction: Role modeling by smokers may influence smoking among children and young adults. Most work on smoking by occupation has focused on health workers. A unique opportunity to explore smoking by occupation is presented in New Zealand (NZ) due to inclusion of a smoking status question in most national censuses since 1976. Our aim was to assess trends in smoking prevalence among potential role model occupational groups in NZ., Methods: Adult smoking status by occupation was obtained from the 1981 census (N = 1,321,323) and 2006 census (N = 1,744,479). Subjects were aggregated into 5 broad groups of potential role-model occupations: teachers, uniformed services, health-related occupations, public figures, and sportspeople/entertainers. Age and sex-standardized current smoking prevalences were calculated using the 2006 NZ employed population as the reference standard., Results: Standardized smoking prevalence among the employed population was 34.5% in 1981 and had declined 37% in relative terms and 12.8% in absolute terms to 21.7% in 2006. Relative declines in smoking prevalence between 1981 and 2006 ranged from 35% to 60% among the role model occupational groups and absolute declines from 8.3% to 19.9%. Māori had higher smoking prevalence and lower relative declines in prevalence in each occupational group from 1981 to 2006, compared with non-Māori. Specific occupations mostly had low smoking prevalences--particularly doctors and teachers. But some role model occupations had high crude smoking prevalences in 2006 (up to 47%)., Conclusions: Persisting high smoking prevalence among some occupational groups suggest that additional targeted smoking cessation support for role model occupational groups may be justified.

Objective: To examine the influences on contemporary smokefree area policy development in New Zealand., Method: Semi-structured interviews were conducted with 62 New Zealand politicians and senior officials. They were asked about their views of possible interventions to reduce smoking around children, and how to achieve progress on smokefree homes, cars and public places. Transcribed data were analysed for themes, some of which were determined by the questions asked, and some emerged from the dynamic nature of the interviews., Results: Policymaking for smokefree areas was seen by participants as a complex, highly politicised activity, concerned with balancing a number of factors including evidence, personal experience, concern for smokers, and the desire for public support for policy. The majority of participants were cautious about making substantive policy moves on smokefree places because of their perception of the issue as highly controversial, their wish to avoid public resistance and their desire for community engagement. Preference was shown for a policy approach based on persuasion rather than legislation, as a means to make progress on smokefree cars and outdoor spaces., Conclusions: The results indicate the need for good communication of the acceptability and benefits of legislative smokefree changes to both the political and public arena., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Smokefree street policies are relatively rare, and little has been published on the methods for establishing an evidence base to inform such policy making. We aimed to (a) pilot methods for such data collection in New Zealand, a country where local governments are actively pursuing outdoor smokefree policies and (a) to provide data on smoking behavior, attitudes toward smokefree policies, and levels of smoke exposure on streets in Wellington., Methods: Three methods were piloted: (a) systematic observation of smoking behavior by observers walking a standard route of major streets, the "Golden Mile" (GM) in Wellington (n = 42 observation runs); (b) measurement of fine particulate levels (PM(2.5)) along this route and with purposeful sampling in selected settings; and (c) an attitudinal survey of pedestrians along sections of this route., Results: Each of the 3 methods proved to be feasible in this urban setting. A total of 932 smokers were observed during 21 hr of observation, an average of 7 smokers every 10 min of walking. Air monitoring indicated fine particulate exposure. Levels of (mean) PM(2.5) were 1.5 times higher during periods when smoking was observed than when they were not (9.3 vs. 6.3 μg/m(3), p = .002). Dose-response patterns were observed for smoking proximity and for smoker numbers. Surveying pedestrians (n = 220) with a brief questionnaire achieved an 81% response rate and was able to identify variation in support for a smokefree GM by different groups (overall support was 55.9%, 95% CI = 49.3%-62.4%). Reasons for support were also identified, for example, perceived health hazards, at 34.1%, was the main reason., Conclusions: These methods can provide information that may contribute to the smokefree streets policymaking process and may also be relevant to informing other smokefree outdoor policies.

Aim: To further explore the views of New Zealand-based Pacific policymakers on smoking in general, smoking in public and private spaces, and smoking around children., Methods: Key informants (n = 18) were recruited and interviewed by Pacific interviewers during May-October 2008, in person or by phone., Results: The interviews revealed a great depth of feeling about smoking in general, smoking in public places, and smoking around children. There was considerable variance of opinion on the extent to which smokefree areas should be extended, with some informants reluctant to interfere with smokers' "choices" There was a general consensus that adults' right to smoke should be limited by social and ethical responsibilities to children., Conclusions: The strong feelings found in favour of tobacco control by some of the interviewees is notable. Mobilising such feelings may help facilitate further progress for advancing tobacco control for Pacific communities in New Zealand and for assisting tobacco control in other South Pacific island nations.

Aim: To determine obstacles/opportunities within policy processes, for smokefree interventions appropriate to Maori. In particular, to explore Maori policymakers' ideas on how to achieve progress on smokefree homes, cars and community property., Methods: Documents and interviews with 16 senior Maori officials and Members of Parliament, and nine interviews in two case studies, were used to explore Maori policymakers' ideas for (i) Progress, within relevant policy processes, on smoking in homes, cars and community property; (ii) Particular interventions that the interviewees felt were most and least effective, practical, sustainable, politically feasible or desirable in some way; (iii) The context, and obstacles and opportunities for such interventions. The case studies were of a Maori health service and a group of Maori District Health Board managers., Results: Several key themes emerged from the research including, (i) children as drivers for change, (ii) strong national and local indigenous leadership needed for change, (iii) delivering smokefree messages as part of wider healthy living approaches, (iv) targeting of the messages for greatest impact for Maori, (v) need for a Maori approach, not a general approach, (vi) central and local government having a significant role in the prevention of tobacco harm, (vii) ideas on how tobacco tax revenue should be spent on tobacco control, and (viii) the rights of children to smokefree environments., Conclusions: Results indicate that indigenous specific approaches and indigenous leadership are critical for Maori tobacco-free advances. Harnessing indigenous values and principles related to health, family and children was the preferred method of these Maori policymakers for delivering social marketing messages.

Background: The internet is an ideal forum for tobacco marketing, as it is largely unregulated and there is no global governing body for controlling content. Nevertheless, tobacco companies deny advertising on the internet., Objective: To assess the extent and nature of English language videos available on the Web 2.0 domain 'YouTube' that contain tobacco brand images or words., Methods: The authors conducted a YouTube search using five leading non-Chinese cigarette brands worldwide. The themes and content of up to 40 of the most viewed videos returned for each search were analysed: a total of 163 videos., Results: A majority of the 163 tobacco brand-related videos analysed (71.2%, 95% CI 63.9 to 77.7) had pro-tobacco content, versus a small minority (3.7%) having anti-tobacco content (95% CI 1.4 to 7.8). Most of these videos contained tobacco brand content (70.6%), the brand name in the title (71.2%) or smoking imagery content (50.9%). One pro-smoking music video had been viewed over 2 million times. The four most prominent themes of the videos were celebrity/movies, sports, music and 'archive', the first three of which represent themes of interest to a youth audience., Conclusions: Pro-tobacco videos have a significant presence on YouTube, consistent with indirect marketing activity by tobacco companies or their proxies. Since content may be removed from YouTube if it is found to breach copyright or if it contains offensive material, there is scope for the public and health organisations to request the removal of pro-tobacco content containing copyright or offensive material. Governments should also consider implementing Framework Convention on Tobacco Control requirements on the internet, to further reduce such pro-tobacco content.

We discuss some of the practical and ethical questions that may arise for a jurisdiction where a sinking lid endgame strategy for tobacco supply is implemented. Such a strategy would involve regular required reductions in the amount of tobacco released to the market for sale, sufficient to achieve the desired level of commercial sales by a target date. Tobacco manufacturers would periodically bid to the government for a residual quota. Prices would increase as supply reduced. The price level would be influenced by demand, which in turn would reflect the impact of other interventions to reduce demand and the changing normality of smoking. Higher priced tobacco could result in increased smuggling, theft, illegal sales and short-to-medium-term aggravation of some social inequalities. We suggest that the strategy be introduced in conjunction with a range of complementary interventions that would help reduce demand, and thus help ensure that the possible adverse effects are minimised. These complementary interventions include: providing comprehensive best practice smoking cessation support, better information to smokers and the public, strengthened regulation of tobacco retailing and supply, further controlling the pack and product design, measures to restrict supplies that bypass the increases in product price, strengthened enforcement and combating industry attacks. General prerequisites for a sinking lid strategy include public support for the goal of a tobacco-free society, and strong political leadership. The likely context for initial success in jurisdictions includes geographical isolation and/or strong border controls, absence of significant tobacco production and/or manufacturing and low government corruption.

Introduction: As little is known about the policy making process around smokefree car laws, we aimed to investigate policy makers' views about such laws in a setting where these have not yet been enacted but where published evidence exists on the hazard of smoking in cars and on relevant public support., Methods: A New Zealand (NZ) case study (of the NZ health policy community) used documents and qualitative in-depth interviews with 62 national-level and District Health Board (DHB)-level policy makers (during 2008-2009). Forty were government or nongovernmental organization officials, 5 DHB board members, and 17 Members of Parliament., Results: We found very strong themes of policy maker concern for the vulnerability of children and the need for their protection from secondhand smoke. There were mixed reactions to the idea of a smokefree law for cars with children in them. These themes and mixed reactions spanned both the "left" and "right" political parties. The evidence indicates that smokefree car laws are only barely on the NZ national policy making agenda. They are generally not seen as politically attractive, as effective, or easy to implement., Discussion: In this particular policy setting, there appear to have been assumptions by policy makers about the dominance of adult "privacy" over child protection. The lack of awareness in this particular (NZ) policy community of national-level public support for banning smoking in cars with children and of the progress elsewhere on such laws also suggests the importance of information and advocacy if such laws are to be progressed.

Background: Some countries have started to extend indoor smokefree laws to cover cars and various outdoor settings. However, policy-modifiable factors around smoker support for these new laws are not well described., Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from the NZ Health Survey (a national sample). From this sample we surveyed adult smokers (n = 1376)., Results: For the six settings considered, 59% of smokers supported at least three new completely smokefree areas. Only 2% favoured smoking being allowed in all the six new settings. Support among Maori, Pacific and Asian smokers relative to European smokers was elevated in multivariate analyses, but confidence intervals often included 1.0.Also in the multivariate analyses, "strong support" by smokers for new smokefree area laws was associated with greater knowledge of the second-hand smoke (SHS) hazard, and with behaviours to reduce SHS exposure towards others. Strong support was also associated with reporting having smokefree cars (aOR = 1.68, 95% CI = 1.21 - 2.34); and support for tobacco control regulatory measures by government (aOR = 1.63, 95% CI = 1.32 - 2.01). There was also stronger support by smokers with a form of financial stress (not spending on household essentials)., Conclusions: Smokers from a range of population groups can show majority support for new outdoor and smokefree car laws. Some of these findings are consistent with the use of public health strategies to support new smokefree laws, such as enhancing public knowledge of the second-hand smoke hazard.

Background: Smoking contributes to the 7 to 8 year gap between Maori and non-Maori life expectancy (2006 Census). To inform current discussions by policy-makers on tobacco control, we estimate life-expectancy in 2040 for Maori and non-Maori, never-smokers and current-smokers. If nobody smoked tobacco from 2020 onwards, then life expectancy in 2040 will be approximated by projected never-smoker life expectancy., Method: Life-tables by sex/ethnicity/smoking status for 1996-99 were estimated by merging official Statistics New Zealand life-tables, census data and linked census-mortality rate estimates. We specified six modelling scenarios, formed by combining two options for future per annum declines in mortality rates among never-smokers (1.5%/2.5% and 2.0%/3.5% for non-Maori/Maori; i.e. assuming a return to long-run trends of closing ethnic gaps as in pre-1980s decades), and three options for future per annum reductions in the mortality rate difference comparing current to never-smokers (0%, 1% and 2%)., Results: In 1996-1999, current smokers had an estimated 3.9 to 7.4 years less of life expectancy relative to never-smokers. This smoking difference in life expectancy was less among Maori than among non-Maori. If the 2006 census smoking prevalence remains unchanged into the future, we estimate the difference in 2040 between Maori and non-Maori life expectancy will range from 1.8 to 6.1 years across the six scenarios and two sexes (average 3.8). If nobody smokes tobacco from 2020 onwards, we estimate additional gains in life expectancy for Maori ranging from 2.5 to 7.9 years (average 4.7) and for non-Maori ranging from 1.2 to 5.4 years (average 2.9). Going smokefree as a nation by 2020, compared to no change from the 2006 Census population smoking prevalence, will close ethnic inequalities in life expectancy by 0.3 to 4.6 years (average 1.8 years; consistently greater for females)., Discussion: If smoking persists at current rates it will become an even greater constraint on life expectancy improvements for New Zealanders in the future. Continued increases in life expectancy, and closing of the Maori:non-Maori gaps in life expectancy, would be greatly assisted by the end of tobacco smoking in Aotearoa-New Zealand by 2020.

Background: Tobacco retail displays promote smoking experimentation among youth; however, little is known about their effect on smokers making a quit attempt. Calls to ban tobacco retail displays would be strengthened if this measure would deter initiation and support cessation., Methods: Semistructured in-depth interviews were conducted with 20 individuals, from two New Zealand provincial cities, who had attempted to quit smoking in the last 6 months., Results: Tobacco products had high visibility, and elicited emotional and physical reactions that created on-going temptation, complicated cessation attempts and stimulated impulse purchases. Participants strongly supported banning tobacco retail displays primarily because they thought this would reduce youth initiation, promote greater consistency with smoke-free promotions and assist those attempting to quit., Conclusions: The effects of tobacco retail displays on smokers making a cessation attempt are explored. The findings are consistent with experimental and survey research, and expand a growing evidence base that supports government-mandated bans on tobacco retail displays.

Aim: To examine smoker support for tobacco tax and for increased dedicated tobacco taxes, along with associations forany such support., Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey utilizes the NZ Health Survey (a national sample). From this sample, we surveyed adult smokers (N = 1,376)., Results: Most smokers considered that the current level of tobacco tax is "too high" (68%), but a majority (59%) would support an increase in tobacco tax if the extra revenue was used to promote healthy lifestyles and support quitting. There was majority support for a dedicated tobacco tax increase among all sociodemographic groups of smokers (including Māori, Pacific, and Asian smokers). In the fully adjusted multivariate model, significant associations with support for a dedicated tax increase included higher deprivation level (adjusted odds ratio [AOR] = 1.15) and suffering one form of financial stress (AOR = 1.81, 95% CI = 1.18-2.78). Other significant associations with support included concern about the smoking impacts on health and quality of life (AOR = 1.41), expressing support for tobacco control regulation (AOR = 1.83), and strength of intention to quit (AOR = 1.30)., Discussion: A majority of smokers from all sociodemographic groups supported an increase in tobacco tax if it was dedicated to quitting support and health promotion. The higher support among smokers with stronger intentions to quit is consistent with other evidence that smokers value tobacco control regulation such as high taxes to help them achieve their long-term quitting goals.

Tobacco affordability, prices and tobacco tax rates have considerable effects on smoking uptake, consumption, and quitting. We examined the trends in New Zealand per capita tobacco consumption and real cigarette prices from 1975-2008. Since 1984, there has been a close inverse relationship between real price and per capita tobacco consumption. Thus price increases drive consumption falls. However, in the periods of 1992-1997 and 2002-2008, both price and consumption were largely stable. The stability since 2002 means other tobacco control interventions have been undercut by increased tobacco affordability (due to increased average real incomes). Furthermore, the lack of tobacco tax increases (to be used to fund better tobacco control) is against majority surveyed New Zealand public opinion, and may be contrary to even smokers' views. The great majority of smokers, who want to quit, could be assisted by more extensive programmes funded by the extra revenue from tobacco tax increases. These could include more prime-time mass media campaigns and greater Quitline capacity. Tobacco tax increases are a highly evidence-based policy that could help reduce harm to the health of New Zealanders and reduce health inequalities.

Aim: To clarify the extent of use of foreign (including duty free, foreign normal retail and smuggled) tobacco, and to estimate missed government tax revenue in a geographically isolated country., Methods: Discarded cigarette packs were collected on the streets of four cities and six New Zealand towns/rural locations between November 2008 and January 2009., Results: Out of a total of 1310 packs collected, 42 foreign packs were identified (3.2%, 95% CI 2.4% to 4.3%). Overall, the distribution of packs by country and company was not suggestive of any clustering that might indicate smuggling. At 3.2% of packs being "foreign", the New Zealand government is losing around $36 million per year in tobacco-related tax relative to if all this tobacco was purchased in New Zealand. For various reasons (including that it was not possible to identify packs bought duty free within New Zealand, and other New Zealand survey data indicating duty free product use at 3.8% of packs), the figure reached is probably an underestimate of the true level., Conclusion: The New Zealand government is missing out on revenue that could be used for improving the funding of tobacco control, and smokers are being exposed to cheaper tobacco thus increasing their risk of continuing to smoke. This government and other governments can and should act at the international and national levels to end the sales of duty free tobacco.

Aims: To describe smoker support for new smokefree laws covering cars and outdoor settings, in a national sample of New Zealand (NZ) smokers., Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) uses as its sampling frame the NZ Health Survey (a nationally-representative sample interviewed face-to-face). From this sample we surveyed by telephone adult smokers (n=1376). Along with adjustment for the complex sample design, there was weighting of the results to attempt to adjust for the non-response at various points (i.e. there was an overall response rate of 33%)., Results: A majority of this national sample of smokers supported three new smokefree areas (albeit with some potential for response bias not adequately addressed by the weighting process). That is, only a minority agreed that smoking should be allowed: in cars with pre-school children (3%), anywhere in outdoor eating areas (22%), and at council-owned playgrounds (32%) (with a more equivocal minority for "within 5 metres of the entrance to public buildings" (48%)). These attitudes were generally compatible with the findings that most of these smokers (87%) reported trying to minimise the amount that non-smokers were exposed to their cigarette smoke, and reported never smoking in a car with non-smokers (73%). Nevertheless, there were still domains where most smokers thought smoking should be allowed--e.g. on lifeguard-patrolled beaches (55%) and in at least some of the outdoor seating areas of restaurants/cafes (51%) and pubs (83%)., Conclusions: There was majority support by these New Zealand smokers for three new types of smokefree areas not covered by current smokefree legislation (including in cars and some outdoor areas). These findings suggest it is a reasonable option for central government and local government authorities to further study and consider new smokefree laws.