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]

Modelled impacts of outlet reduction

Pearson AL et al. Tob Control. 2014.

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

richard.edwards@otago.ac.nz

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