The Smokefree Aotearoa

2025 action plan: is the

endgame now in sight?
Richard Edwards
ASPIRE Aotearoa Research Centre
University of Otago, Wellington
Aotearoa New Zealand
Māori leadership and origins of
Smokefree Aotearoa 2025
Smokefree Aotearoa – a timeline
Ø2006-2010: Sector mobilisation around endgames

Ø2010: Māori Affairs Select Committee Inquiry

Ø2011: Government commits to Smokefree 2025 goal

…Government agreed with the goal of

reducing smoking prevalence and
tobacco availability to minimal
levels, thereby making New
Zealand essentially a smokefree
nation by 2025. (Parliament response
to MASC)
 Smokefree Aotearoa – a timeline
Ø2011-2021: No plan or strategy, largely business as
usual measures, e.g.

Annual above CPI tax increases POS display ban 2012

2011-2021
Cessation services (prioritizing
Māori), reorganized 2015-16
Mass media (some Māori
focused) 2011-2021, reduced
expenditure
Smokefree prisons 2011
Standardised packaging 2018
Enhanced health warnings (incl
Māori) 2018
Vaping regulation 2020
Smokefree cars 2021
Trends in adult daily smoking 2006/7-
2018/19 (NZHS)
ASAP strategy, 2017
How can we get to a
Smokefree Aotearoa?
Make smoked tobacco
products:
• Less affordable
• Less available
• Less addictive and less
appealing/palatable
Intensify what we currently
do
Greater availability of
alternatives to smoked
tobacco products
https://aspire2025.org.nz/hot-topics/smokefree-action-plan/
 All change in 2021

Consultation

April 2021 December 9 2021

 Key features of Smokefree Action plan
2. Comprehensive approach: To accelerate progress towards
Smokefree 2025, we must change
beyond ‘business as usual’ how we tackle smoking. We will not
(BAU) and individualized achieve it with a business-as-usual
approach.
interventions
• Bold and innovative measures not “This action plan
previously implemented acknowledges that smoking is
not an individual issues.
• Structural measures that tackle supply
Smoking is a community
and nature of tobacco products issue and social issue”
• Supported by enhanced BAU measures
“… the plan is about more than mobilising communities and providing better support for
individuals. It also aims to radically change the smoking environment to make it easy for
all New Zealanders to live smokefree, by tackling everything about the product, including
where it is sold and what is in it.”
Individual cessation
approaches Relapse

Assisted

Non-
smokers Smokers Quit
attempts
Initial
success

Unassisted

Long term
success
 Product
Population-based modification
Relapse Product
approaches Accessibility

Assisted

Non-
smokers Smokers Quit
attempts
Initial
success

Unassisted
Three world-leading
measures

Retail supply
reduction
 VLNCs – a pivotal measure
• Strong theoretical support – nicotine main constituent causing
addiction

• Reviews of RCTs etc find people given VLNCs:

• Dislike smoking the cigarettes
• Smoke less
• Are less exposed to toxins
• Are less dependent
• Are more likely to try to quit
• Are more likely to quit
• Likely substantial impact on smoking uptake
• Modelling studies suggest profound impact
NB Possible synergy with vaping
Quit rates
18% RNC vs 4%
UNC

NB Participants
not planning to
quit in next 6
months
Perceived impact of action plan measures
(NZ ITC/EASE survey, W3, 2020-21)

Reduce the amount I smoke

Retailer reduction

Switch to vaping/ e-cigarettes Mandated VLNCs

Quit smoking entirely

Carry on smoking like I do now, but find a way

to get the cigarettes or tobacco I want to…
Carry on smoking like I do now, with the
cigarettes or tobacco that were available

Something else (specify)

0 10 20 30 40 50 60
%
https://tobaccocontrol.bmj.com/cont
ent/tobaccocontrol/early/2023/01/10
/tc-2022-057655.full.pdf
(Substantial) Retailer reduction
Action Plan/legislation
• Reduce from around 6000 to
600 or less 1 July 2024
Logic
• Highly addictive and lethal
products should not be sold as
everyday consumer items
• Higher retail density associated
with increased smoking
prevalence, reduced quitting
and increased relapse
• Retailer concentration in low
SES areas entrenches health
inequities
(Substantial) Retailer reduction
Anticipated impacts:
• Signal uniquely hazardous nature
of smoked tobacco products
• Greatly reduce availability
• Promote and support quitting
• Trigger to quitting
• Reduce relapse
• Reduce uptake
• Promote equity https://blogs.otago.ac.nz/pubhealthexpert/
https://aspire2025.org.nz/hot-topics/hot-topic-
action-plan-for-smokefree-aotearoa-2025/
Perceived impact of action plan measures
(NZ ITC/EASE survey, W3, 2020-21)

Reduce the amount I smoke

Retailer reduction

Switch to vaping/ e-cigarettes Mandated VLNCs

Quit smoking entirely

Carry on smoking like I do now, but find a way

to get the cigarettes or tobacco I want to…
Carry on smoking like I do now, with the
cigarettes or tobacco that were available

Something else (specify)

0 10 20 30 40 50 60
%
 https://tobaccocontrol.bmj.com/conte
nt/tobaccocontrol/early/2023/01/30/t
c-2022-057834.full.pdf

“It would be a really good way

for me to cut down… I’m over it
Qualitative study with 24 people who smoke … I mean, it’s disgusting, it stinks.
• Many anticipated using alternative outlets or bulk Why do I put something into my
purchasing tobacco body that is harming me? Self-
harm, isn’t it?”
• But large majority or most expected policy would:
• spur quit attempts,
• reduce relapse among people who had quit, You’re dealing with an addict .…
• protect young people from smoking uptake, We need to be realizing that
• encourage people to switch to alternative nicotine products. this is not choice. This is
addiction.”
• Most foresaw some adverse outcomes e.g.
• increased crime and reduced viability of local businesses
• financial difficulties for people who smoke
“That’s going to put them more
out of pocket because they're
• Conclusion: either gonna be overbuying…
“Adopting a holistic well-being perspective, such as those developed or [they’ll] substitute, you
by Māori, could address concerns about unintended adverse know, cut things out of their
outcomes and provide comprehensive support to people who smoke
grocery list.”
as they adjust to a fundamental change in tobacco availability.”
Smokefree generation
Proposal
• Continuously increase legal age people can be
sold smoked tobacco products (STPs)
Logic
• Acknowledges lack of true informed choice
during uptake
• Eliminates ‘rite of passage’ effect (cf T21)
• STPs identified as uniquely hazardous
Anticipated impacts
• Gradual phasing out of STP availability
• Reduced smoking uptake
• Strongly pro-equity (2019-20 current smoking
among Māori aged 15–24 = 26.4%)
Reactions to action plan in New Zealand
Negative
Reactions

British America Tobacco said:

“…there is a very real risk that many of its
proposals in this action plan will directly drive
more demand and more sales of illegal
tobacco…. It simply generates more cash for
criminals.”
https://www.rnz.co.nz/news/national/440560/smokefree-group-says-
cigarette-purchase-age-would-not-dent-smoking-rates
Guess who is in the background?
Analysis of tobacco industry submissions
on draft NZ Action Plan
Support/ Opposition
BAT Imperial JTI
Strengthen the tobacco control
system X – –
Enhance existing initiatives
ü ü –
Reducing retail availability of tobacco
X X X
Smokefree generation policy
X X –
Mandating very low nicotine
cigarettes X X X
Prohibiting filters X X X
Prohibit tobacco product innovations
X X X
Minimum price for tobacco
X X –

Slide, courtesy of Lindsay Robertson

Support for action plan measures (NZ
ITC/EASE survey, W3, 2020-21; W2 2018)
Support for increased government spending on media
campaigns to discourage youth and young people from
starting to smoke (W3)

Support for a law to prevent people currently 18 or

younger from ever buying cigarettes or tobacco to
create a tobacco-free generation (W2)

Support for a law to reduce the nicotine in cigarettes

and tobacco to make them less addictive, provided
they could get nicotine in products other than…

Support for increased government spending on media

campaigns to promote quitting smoking (W3)

Support for a law to reduce the number of places in NZ

that are allowed to sell tobacco - from around 6000 to
300 (W3)

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

All Recent quitters Smokers

What about vaping? Legislation introduced in
2020 and additional
regulations subsequently/
under consultation e.g.
• Comprehensive marketing
and sponsorship ban
• Controlled retail availability
with restricted range of
flavours in non-specialist
vape stores
• Education on vaping as
alternative directed at
people who smoke
Aim to balance preventing
youth uptake and use and
supporting people who
smoke to switch to less
harmful products
Trends in adult (≥15 years) current (≥ monthly) and daily
smoking and e-cigarette use (NZHS 2011/12 to 2021/22)
Trends in adult (≥15 years) daily smoking by ethnicity (NZHS
2011/12 to 2021/22)
Trends in 18-24 year olds current (≥ monthly) and daily smoking
and e-cigarette use (NZHS 2011/12 to 2021/22)
Profile of people who smoke (EASE/NZ ITC 2020/21)
• Introduced to Parliament (First Reading) July 26 2022,
passed and Royal Assent December 16 2022
• Includes legislation for three key measures
• Mandated denicotinisation of smoked tobacco products (STPs) –
implementation April 1 2025
• Reduced retail availability of STPs - implementation July 1 2024
• Smokefree generation for STPs - implementation January 1 2027

https://www.parliament.nz/en/pb/bills-and-laws/bills-proposed-laws/document/
BILL_125245/smokefree-environments-and-regulated-products-smoked-tobacco
 Next steps and timelines
• Increased funding and implementation underway for many
measures e.g.
• Smokefree Taskforce and Pacific Assurance group
• Māori community activators
• Increased funding for smoking cessation, public education,
enhanced Customs enforcement
• Youth vaping campaign
• Consultation currently on regulations to implement
Smokefree legislation
• 2023-2027
• Progressive implementation of key policy interventions and other
actions

NB election – October 2023!

Smokefree Aotearoa - summary
• Smokefree action plan and legislation key features:
• Comprehensive approach, goes beyond BAU
• Focus on eliminating inequities
• Commitment to strengthening Māori engagement and
governance
• Supply and product regulation measures, including three
innovative and world-first measures
• Will be highly contested by tobacco industry and its
allies
• If fully implemented should ensure Smokefree 2025
goal achieved for all peoples in Aotearoa with massive
improvement in health and reduced health inequities
• Possible wider (global) precedent/blueprint
Further information
ASPIRE Aotearoa website
https://aspire2025.org.nz/
https://aspire2025.org.nz/hot-topics/hot-topic-action-plan-for-smokefree-aotearoa-2025/

Public Health Communication Centre Briefings

https://www.phcc.org.nz/briefing/smokefree-aotearoa-world-leading-developments-
profound-public-health-implications

https://www.phcc.org.nz/briefing/removing-nicotine-tobacco-key-component-current-
smokefree-bill
https://www.phcc.org.nz/briefing/reducing-tobacco-retail-availability-counterarguments-
industry-claims
https://www.phcc.org.nz/briefing/phasing-out-smoking-tobacco-free-generation-policy
https://www.phcc.org.nz/briefing/smokefree-generation-perspectives-young-people
https://theconversation.com/forget-tobacco-industry-arguments-about-choice-heres-
what-young-people-think-about-nzs-smokefree-generation-policy-193529

https://www.phcc.org.nz/briefing/what-can-aotearoa-nz-learn-australias-new-vaping-
policies
Thank you
richard.edwards@otago.ac.nz