Tobacco Achievements

Foreword

When I first entered parliament in 1996, one in four New Zealanders aged 15 and over, were smoking daily. Secondary smoke exposure was part of our life; as was the loss of life to far too many generations of New Zealanders who die prematurely from smoking.

Tobacco reform was therefore a key priority for me when I was appointed Associate Minister of Health in 2008. I am so proud of the amazing achievements engineered by a highly motivated workforce; a passionate community of advocates and a responsive health sector in creating a pathway to a smokefree Aotearoa by 2025.

In a relatively short period of time we have been able to reduce tobacco consumption in all types of tobacco products and across all population groups. The strategy has been a comprehensive campaign in all spheres of influence – health education, legislation, smoking cessation, and tobacco taxation. The political will to reduce smoking prevalence and consumption has been encouraging; the influence of the policy milestones negotiated in the Relationship Accord with the Māori Party has also been significant.

There are still areas of significant challenge. As a nation we must continue to support interventions which can support Māori, young adults and people with lower socio-economic status to become smokefree. There is more that we can do in enacting the Smokefree Environments Act. I have been impressed by the efforts of some local government bodies to make public outdoor spaces smokefree. I have loved the efforts in Wainuiomata to encourage their community to think about the children before they light up.All of us can become wellbeing champions in our own homes, our marae, and our communities.

The Government’s goal to be Smokefree by 2025 rests in all of our hands. It is a driven by the vision that families are entitled to be well; to enjoy long life; to be free of chronic illness. I commend this tobacco achievements report to all New Zealanders as a powerful message of what we can achieve, when we work together in the common pursuit of a Smokefree Aotearoa.

Mauri Ora!

HonTarianaTuria

Associate Minister of Health

Minister Turia was awarded the World Health Organisation Western Pacific Region award for work on tobacco control on 31 May 2014, World Smokefree Day

Summary

Excellent progress has been made towards reducing harm caused by tobacco use. Tobacco use results in between 4,500 and 5,000 deaths a year, is the single largest cause of preventable death and chronic illness in this country, and is a major factor in health inequality. The lifespan of those smokers who die prematurely from smoking is, on average, reduced by 15 years. Both smoking prevalence and tobacco consumption, the two main measures of progress in tobacco control, are falling rapidly.

The 2013 Census and the New Zealand Health Survey of 2012/13 reported daily smoking to be 15%.1 and 15.5% respectively. As detailed below, this decline in smoking rates has occurred in all ethnic groups, across all deprivation groups, among both genders, and among most ages.

The decrease has not, however, been spread evenly across those groups. Smoking prevalence and consumption are higher among Māori, young adults and people with lower socio-economic status. Those communities bear a disproportionate burden of smoking-related illness and death.

Tobacco consumption hasplummeted. After falling gradually between 2000 and 2008(generally hovering around the 1000 cigarette equivalents per year mark), tobacco consumption has dropped from 961 cigarette equivalents per capita (adult over 15 years of age) in 2009 to 683 per capita in 2013, a decrease of about 29%. The sale of all types of tobacco products - manufactured cigarettes, roll-your-own cigarettes, cigars and pipe tobacco - is in decline.

What has brought about these dramatic changes? New Zealand has a comprehensive tobacco control programme, which includes health education, legislation, smoking cessation support and tobacco taxation. All are currently in use in New Zealand. They are most effective when applied in combination.

Although it is difficult to untangle the contributions of each component, there can be no doubt that raising the price of tobacco products through taxation increases has been the most important single contributor, particularly to the drop in tobacco consumption and the decline in youth smoking. In 2013, daily smoking among 14-15 year olds was down to 3.2 % and 75 % had not smoked a single cigarette. Smoking is no longer normal in this age group and most will remain smokefree for life.

Price measures alone cannot achieve the Government’s tobacco goal. Informing people of the harm caused by tobacco use through media campaigns, health warnings on packets and the like are crucial. The Māori Affairs Committee’s inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori gave tobacco issues a high public profile and the Government adopted its main recommendation of an essentially smoke-free Aotearoa by 2025.

Smoking cessation support services have been strengthened and cessation aids have become more accessible. The Government health target requiring patients in secondary hospital and primary care to be asked their smoking status and provided with brief advice and support to quit has led to many thousands of smokers being encouraged and helped to stop smoking.

The Smoke-free Environments Act 1990 has been amended. Work to further reduce tobacco advertising by banning the display of tobacco products in retail outlets was passed in July 2011 and the main provisions came into force a year later. Government consideration of further measures to minimise tobacco advertising by introducing standardised tobacco packaging and new larger health warnings, are well advanced. Legal provisions to protect people from second-hand smoke have not changed, but surveys show a gradual decline in exposure rates and many local authorities, encouraged by non-government organisations, have adopted, and in some cases extended, the smokefree areas within their jurisdictions.

These developments have been magnificently supported by the non-government organisations that support tobacco control and the tobacco research community has provided high quality evidence to inform the development of policy and to promote innovative ways to help smokers to quit.

As a result of these efforts promising progress has been made towards New Zealand becoming an essentially smoke-free nation by 2025, but it is still an ambitious target. Much remains to be done if the target is to be achieved. Hopefully the new Pathway to Smoke-free New Zealand 2025 Innovation Fund will help us to reach those priority groups among whom smoking rates remain far too high.

Reduced Smoking Prevalence and Consumption

1Smoking Prevalence

Information on smoking prevalence has been obtained primarily from two sources, the New Zealand Health Survey (NZHS) reports prepared by the Ministry of Health’s Health and Disability Intelligence Unit and data from the New Zealand Census which included two questions on smoking in 1981, 1996, 2006 and 2013.

The 2013 Census showed that regular (daily) smoking for people aged 15+ years had fallen from 20.9 % in 2006 to 15.1 % in 2013. The New Zealand Health Survey, using different methodology, reported daily smoking to be 15.5 % in 2012/13.

While the Census reports “regular” smoking (essentially daily smoking), the New Zealand Health Survey reports its findings primarily in terms of “current” smoking prevalence,that is,those who smoke daily, weekly or monthly.

Detailed smoking prevalence data from the NZHS, both daily and current smoking rates broken down by age, ethnicity and gender, are available at Note that some of the NZHS data in this report is being prepared for publication and is subject to change.

Smoking prevalence is declining in all ethnic groups, across all deprivation groups, among both genders and amongst most ages. New Zealand has seen a significant decrease in both current and daily smoking since 1996/97. In 1996/97, 25.2% of the adult population (aged 15+ years)weredaily smokers. By 2012/13, this rate had dropped to 15.5% which equates to around 554,000 adult daily smokers.

Daily smoking, 1996/97-2012/13 (age-standardised prevalence)

Data sources: 1996 = 1996/97 New Zealand Health Survey (NZHS); 2002 = 2002/03 NZHS; 2006 = 2006/07 NZHS; 2011 = 2011/12 NZHS; 2012 = 2012/13 NZHS

Census returns also showed a large decline in adult smoking prevalence, from 20.9 % in 2006 to 15.1% in 2013 for the New Zealand population aged 15+ years - a remarkable decline of 22.5 %.

Smoking Prevalence by age

According to the New Zealand Health Survey there has been a significant decrease in the rate of current smoking in 15-19 year olds from 19.8% in 2006/07 to 12.7% in 2012/13.

Between 2006/07 and 2012/13, the largest decline in current smoking prevalence occurred amongst 15-19 year olds (36%) followed closely by those aged 65-74 years (27%). The third significant decline was recorded with smokers in the 25-34 year old age group (13%). Those aged 75 years plus recorded a slight increase in smoking prevalence rates, although this was not significant.

Time trend of current smoking prevalence by age group between 2006/07 and 2012/13

Age group / 2006/07(%) / 2012/13(%) / Relative percentage change (%)
15-19 / 19.8 / 12.7 / -36*
20-24 / 27.3 / 25.4 / -7
25-34 / 28.3 / 24.5 / -13*
35-44 / 22.3 / 20.5 / -8
45-54 / 21.4 / 20.0 / -7
55-64 / 15.0 / 14.8 / -2
65-74 / 10.9 / 8.0 / 27*
75+ / 4.0 / 4.4 / 9

Data sources: NZHS 2006/07 and NZHS2012/13

*There is a statistically significant (p<0.05) difference between the prevalences in 2006/07 and 2012/13

Although there was a significant decrease in young female smoking rates in the 15–19 age group between 2006/07 and 2012/13, there was no significant change for their male counterparts.

For 15-17 year olds the current rate of smoking decreased from 15.7% in 2006/07 to 8.0% in 2012/13. The Action on Smoking and Health (ASH) Year 10 Survey also found large decreasesin smoking rates among 14 and 15 year old students.

Time trend of smoking prevalence among 14 and 15 year olds

Smoking status (%) / 1999 / 2003 / 2006 / 2008 / 2009 / 2010 / 2011 / 2012 / 2013
Daily / 15.6 / 12.1 / 8.2 / 6.8 / 5.6 / 5.5 / 4.1 / 4.1 / 3.2
Weekly / 6.7 / 4.3 / 3.3 / 2.6 / 2.7 / 2.4 / 2.0 / 1.8. / 1.8
Monthly / 6.3 / 4.3 / 2.8 / 2.5 / 2.6 / 2.1 / 2.1 / 1.8 / 1.8
Regular / 28.6 / 20.7 / 14.2 / 11.9 / 10.9 / 10.0 / 8.2 / 7.7 / 6.8
Never smoked / 31.6 / 42.4 / 54.0 / 60.7 / 64.0 / 64.4 / 70.4 / 70.1 / 75.1

Data source: ASH year10 snapshot survey 1999-2013

Similar to the NZHS, the 2013 census showed large decreases in smoking prevalence in all age groups compared with the 2006 census, particularly in the younger age groups.

Time trend of regular (daily) smoking prevalence by age group between 2006 and 2013 Censuses

Age group / 2006(%) / 2013(%) / Relative percentage change (%)
15-19 / 19 / 10 / -42
20-24 / 30 / 21 / -30
25-34 / 27 / 20 / -26
35-44 / 24 / 18 / -25
45-54 / 22 / 18 / -18
55-64 / 16 / 13 / -19
65+ / 8 / 7 / -12

Data sources: NZ Census 2006 and 2013

Smoking prevalence by ethnicity

The general decline in the overall prevalence of smoking in recent years has not occurredat the same rate across all population groups, with some groups showing greater declines than others.

As shown in the table below, between 2006/07 and 2012/13 the European/Other group showed the largest decline (16%) amongst the ethnic groups.

Time trend of current smoking prevalence by ethnicity between 2006/07 and 2012/13

Ethnic group / 2006/07(%) / 2012/13(%) / Relative percentage change(%)
Māori / 40.2 / 38.2 / -5
Pacific / 26.2 / 23.9 / -9
Asian / 10.6 / 10.3 / -2
European/Other / 20.3 / 17.0 / -16*

Data sources: NZHS, 2006/07 NZHS; 2012/13

*There is a statistically significant (p<0.05) difference between the prevalences in 2006/07 and 2012/13

According to the 2013 ASH Year 10 smoking survey of 14 and 15 year olds, smoking among Māori in Year 10 is also continuing to show a rapid decline. Daily smoking amongst Māori in Year 10 has declined to 8.5% in 2013 compared to 26.9% in 2003 and 30.3% in 1999. Regular smoking has also greatly reduced for Māori Year 10 students. For 2013, the figure is 14.7% compared to 20.9% in 2010, 23.3% in 2009 and 42.8% in 1999.

Census returns showed large declines in smoking prevalence among all ethnic groups.

Time trend of regular (daily) smoking prevalence by ethnicity between 2006and 2013

Ethnic group / 2006(%) / 2013(%) / Relative percentage change (%)
Māori / 43 / 33 / -23
Pacific / 30 / 23 / -23
Asian / 11 / 8 / -27
Middle Eastern, Latin American, African / 15 / 11 / -27
European / 19 / 14 / -26
Total / 20.9 / 15.1 / -22.5

Data sources: NZ Census: 2006 and 2013

Smoking prevalence by neighbourhood deprivation

Current smoking prevalence fell in all neighbourhood socioeconomic deprivation groups between 2006/07 and 2012/13, but the declines were not even across all groups. Adults living in the middle quintiles (2, 3 and 4) showed the biggest declines (22%, 17% and 17% respectively). Nevertheless, in 2012/13 smoking prevalence remained lowest in quintile 1 and highest in quintile 5.

Time trend of current smoking prevalence by neighbourhood deprivation between 2006/07 and 2012/13

Neighbourhood deprivation / 2006/07(%) / 2012/13(%) / Relative percentage change (%)
Quintile 1 / 13.0 / 12.8 / -11
Quintile 2 / 17.3 / 13.4 / -22*
Quintile 3 / 20.1 / 16.7 / -17*
Quintile 4 / 24.6 / 20.5 / -17*
Quintile 5 / 33.1 / 31.3 / -5

Data sources: NZHS; 2006/07, NZHS; 2012/13

*There is a statistically significant (p<0.05) difference between the prevalences in 2006/07 and 2012/13.

Smoking prevalence by gender

Current smoking prevalence fell significantly by a similar amount for both males and females (11% and 13% respectively) between 2006/07 and 2012/13. The proportion of females smoking in 2012/13 (17.6%) was significantly lower than the proportion of males smoking (20.0%).

Time trend of current smoking prevalence by gender between 2006/07 and 2012/13

Gender / 2006(%) / 2012(%) / Relative percentage change(%)
Male / 22.4 / 20.0 / -11*
Female / 20.3 / 17.6 / -13*

Data sources: NZHS; 2006/07, NZHS; 2012/13

*There is a statistically significant (p<0.05) difference between the prevalences in 2006/07 and 2012/13.

The Census showed a larger downward trend for daily smokers.

Time trend of regular (daily) smoking prevalence by gender between 2006 and 2013

Gender / 2006(%) / 2013(%) / Percentage change (%)
Male / 22. / 16 / -27
Female / 20. / 14 / -30

Source: NZ Census; 2006 and 2013

2Tobacco Consumption

More than any other measure, changes in tobacco consumption are related to the price of tobacco. Some quit smoking in response to price increases but many more respond by reducing their consumption or, in the case of many young people, not taking up smoking.

The tables below are from different sources and not strictly comparable. The data for 1999–2009 is from Statistics NZ and records tobacco products available for consumption- essentially, product on which excise or duty has been paid. This series was discontinued in 2010 for reasons of confidentiality. The data for 2010-2013 is from the tobacco product sales information provided annually by tobacco manufacturers and importers. The data areissimilar, but not identical.

After falling gradually between 2000 and 2008(hovering around the 1000 cigarette equivalents per year mark), tobacco consumption per adult aged 15+has fallen dramatically from 961 cigarette equivalents per capita in 2009 to 683 cigarettes per capita in 2013, a decrease of about 7.2 % per year. The sale of all types of tobacco products - manufactured cigarettes, roll-your-own cigarettes, cigars and pipe tobacco - is in decline.

Tobacco products released for consumption in New Zealand, 1999–2009

Year / Tobacco products released / Number of cigarette equivalents released per adult (15+years)
Loose tobacco (tonnes) / Manufactured cigarettes (millions) / Loose tobacco per 15+ / Manufactured cigarettes per capita / Total per capita
1999 / 736 / 3119 / 251 / 1062 / 1312
2000 / 841 / 3152 / 281 / 1058 / 1352
2001 / 780 / 2608 / 262 / 875 / 1136
2002 / 810 / 2817 / 265 / 922 / 1187
2003 / 795 / 2367 / 255 / 759 / 1014
2004 / 841 / 2320 / 266 / 733 / 999
2005 / 889 / 2436 / 276 / 757 / 1033
2006 / 879 / 2439 / 269 / 747 / 1016
2007 / 904 / 2445 / 270 / 732 / 1002
2008 / 870 / 2550 / 257 / 755 / 1012
2009 / 856 / 2436 / 250 / 711 / 961

Source: Statistics New Zealand

Tobacco products sold in New Zealand, 2010-2013

Source: Tobacco return sales data 2013 (Health New Zealand)

Notes for both tables:

1.One cigarette equivalent equals one manufactured cigarette or one gram of loose tobacco.

2.One tonne equals 1000 kg.

3.It is assumed that one cigarette equals one gram of loose tobacco and one tonne of loose tobacco equals one million manufactured cigarettes.

4.Calculations of cigarette equivalents are based on tobacco return datafor manufactured cigarettes and loose tobacco released for sale.

5.‘Per capita’ means for each individual (15+ years) in the population.

Achievements through Improved Tobacco Control

1Tobacco Taxation

In October 2009, Cabinet agreed in principle to increase the excise on tobacco products. On 28 April 2010, tax on tobacco products was increased by 10% with an additional 14%increase in the tax on loose tobacco. Increases of 10% on 1 January 2011 and 1 January 2012 were also provided for. The Māori Affairs Committee urged (Recommendation 32) the Government to legislate for further incremental tax increases over and above the annual adjustment for inflation. In October 2012, the Customs and Excise (Tobacco Products—Budget Measures) Amendment Act 2012 legislated for a further four tobacco tax increases of 10% to come into effect on 1 January each year from 2013 to 2016.

The World Health Organization regards increasing the price of tobacco through higher taxes as the single most effective way to decrease tobacco consumption and encourage smokers to quit. Although, price rises do not work alone but they are instrumental in ensuring the overall package of mutually-reinforcing measures (including Health Targets, smoking cessation services and medication, retail controls, smoke-free environments, health warnings, public education and media campaigns) works to maximum effect to reduce smoking levels.

The biggest health gains from increasing tobacco taxes were expected to be among Māori (particularly Māori women), Pacific, and low income communities, who are all significantly over represented in smoking rates. There is also strong evidence that young people are particularly price sensitive when making decisions about smoking uptake. The health benefits of an excise increase are therefore likely to build over time.

Annual adjustments to the tobacco excise, based on movements in the Consumer Price Index (CPI), occur every year, subject to Cabinet approval. In recent years this adjustmenthastaken effect on 1 January. Increases in the tobacco excise over and above the inflation adjustment have occurred from time to time, for example in 1998 and 2000 (a 14% increase). However, the price of tobacco productsis set by the tobacco companies and may be more, less, or the same as the tobacco excise increase.

As noted, the first of the recent series of tobacco tax increases occurred on 28 April 2010. The tax on all tobacco productswas increased by 10% and there was an additional increase of 14% on loose tobacco to align the excise tax on manufactured cigarettes with that on loose tobacco based on the weight of tobacco. The tax on loose tobacco therefore increased by about 25%.

The subsequent tobacco tax increases occurred as follows:

1 January 201110% increase on all tobacco products + CPI of 1.65%
1 January 201210% on all tobacco products + CPI of 4.492%
1 January 201310% on all tobacco products + CPI of 0.86%
1January 201410%on all tobacco products+ CPI of 1.28%

In recommending the Bill that provided for four cumulative increases to the excise tax on tobacco products of 10% from 2013 to 2016 to the House, by majority, the Finance and Expenditure Committee also recommended that the Government: