In interpreting consumption figures, it is important to take into account changes in the price and affordability of cigarettes, as consumption is sensitive to changes in these factors. Together, price and income determine the overall ‘affordability’ of a product. Changes in price are stronger influences on demand than income. There is around three times greater ‘demand elasticity’ for price. (Thomson et al., 2000)
Real average incomes per person have been increasing in recent years (2.1% per annum, 2000-4), though more slowly in 2005 (1.2%). Therefore the effect of increasing real average incomes on promoting demand would have been fairly similar during 2000-5, though possibly slightly less in 2005. Data on the annual level of retail prices of cigarettes and tobacco relative to the All Groups Consumers Price Index (CPI) shows that cigarettes prices were about 20 percent higher in 2005 relative to all consumer prices than they were in the base period of June 1999. Most of this increase occurred before 2003, and the increase since 2003 has been modest. There was about a two percent increase in 2003, and less than one percent in 2004 and 2005.
Quarterly Cigarette Equivalent Deliveries. Original, Trend, and Seasonally Adjusted
0 200 400 600 800 1000 1200 1400 1600 1800 2000 2000 -I 2000- II 2000- III 2000 -IV 2001- I 2001- II 2001-III200 1-IV 2002- I 2002- II 2002-III2002- IV 2003 -I 2003- II 2003- III 2003- IV 2004- I 2004 -II 2004- III 200 4-IV 2005- I 2005- II 2005-III2005- IV 2006- I Quarter Million Original Trend Seas. Adj.
Figure 9.3.5 shows annualised cigarettes and tobacco release in relation to the real price of cigarettes. The around 15% increase in cigarette prices relative to the CPI between 1999 and 2003, was associated with decreases in cigarettes released onto the market, and very likely therefore with reduced per capita consumption. From 2003-5, there were only small increases in cigarette prices relative to CPI, and these were partly offset by increases in real income. During this period there was little change in cigarettes released onto the market.
Figure 9.3.5 Per capita annualised tobacco and cigarettes released onto the New Zealand market and cigarette prices relative to the Consumers Price Index, 1988-2005
9.4. Discussion
9.4.1. Critique of the evidence
Data were available to assess changes in most of the success criteria described in section 9.1. However, there were no data available on motivation to quit and prevalence of quit attempts and quit rates among smokers. In addition, there was very few data available about changes in smoking-related behaviours and prevalence among Māori.
All the evidence described in this section comes from uncontrolled data showing trends over time, with limited data on the many possible confounding influences which may have affected
0 500 1000 1500 2000 2500 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Calendar Year Ci gs per
head & Real
Ci gar et te Pr ice I ndex
Real Cigarette Prices
overall smoking prevalence, tobacco consumption, and quitting behaviour. These include the level of news media coverage of tobacco and health issues and the degree of promotion of smoking cessation services. For Quitline data specifically, call rates and registrations have been shown to vary seasonally, and be affected by television-based media campaigns, changes in access to NRT, media publicity about smoking hazards, and the impact of major
international events; (Grigg et al., 2003; Wilson et al., 2002a; Wilson et al., 2002b; Wilson et al., 2005a). Therefore with any changes observed in prevalence, consumption and quitting behaviour in relation to the SEAA (2003) implementation, there is a problem of valid attribution of causation.
Limitations with the HSC Monitor data due to poor response rates were discussed in section 5.4.1. The reported trends will probably not be affected by these problems.
The results suggesting a decline in prevalence of smoking among year 10 students between 2004 and 2005 are hard to interpret given the long-term decline in youth smoking. Evidence of reductions in the proportion of children reporting both parents smoking between 2004 and 2005 should also be treated with some caution, particularly if accuracy of reporting changed over time. For example, implementation of the SEAA (2003) and other changes reducing the social acceptability of smoking may have increased the rate of “social desirability bias”, where students report less than the true prevalence of parental smoking. Also, if parental smoking inside the home selectively reduced (relative to smoking in other settings) over time, students may have become less aware of their parents smoking than previously. Finally, demographic changes could have had an effect. For example, the decline in the prevalence of parental smoking in the Auckland DHB between 2001 and 2005 (from 37.0% to 30.3%) was partly attributed to the increasing proportion of Asian students (whose parents are less likely to smoke). (Scragg, 2006)
The release of tobacco products onto the New Zealand market is the best available measure of trends in consumption over time j. However, the figures are for the release of tobacco onto the market each quarter. They are not a direct measure of sales or consumption over the same quarter. Hence, the figures may be distorted by increased or decreased releases of tobacco
j An alternative source is the Household Economic Survey, but this is known to seriously under-report household spending on cigarettes by 50 percent or more. (Thomson et al., 2000)
from warehouses in response to changing retail stocks. Their usefulness for assessing the impact of tobacco control interventions like the SEAA (2003) on consumption is therefore very limited in the short-term (quarter to quarter or year to year), though probably valid over longer periods. It is possible that the apparent small increase in per capita release of tobacco to market in 2005 (figure 9.3.4a) represented reduced releases in anticipation of the SEAA (2003) at the end of 2004, followed by a compensatory increase as stocks ran low. The greater release of tobacco in the first quarter of 2005 relative to the equivalent quarters in 2002-4 and 2006, and the smaller amount released in the last quarter of 2004 compared with 2002-3 and 2005 (figure 9.3.4b) supports this interpretation. Supermarket sales have similar limitations and also represent only one part of the retail sector that supplies tobacco, so also only provide limited evidence of overall tobacco sales and consumption. Data on tobacco sales through other retailers such as dairies and convenience stores, or petrol stations was not available. 9.4.2. Conclusions
The introduction to this section noted that changes to tobacco consumption, smoking prevalence and smoking-related behaviours are non-core outcome indicators, and that large changes were unlikely in the short term, and were less likely for the SEAA (2003) since most workplaces were already smokefree by 2004.
However, there was strong evidence of changes in quit attempts and socially-cued smoking. Evidence from the Quitline data suggests that there were increases in caller registrations and the issuing of NRT exchange cards in the six-month period following the SEAA (2003) implementation. This pattern was much stronger when account was taken of the marked reduction in television advertising expenditure by the Quit Group on smoking cessation during early 2005. These findings are consistent with the previous New Zealand work using data from a shorter time period. (Wilson et al., 2005b) The caller registration rate (unadjusted for advertising expenditure) also increased in the six-month period prior to the law change. This may have been related to the media campaign on smokefree homes that was run from April 2004, and the media campaign on the new smokefree legislation that was run in late 2004 (see section 2.4). The results are consistent with the international data on the impact of smokefree laws on smoker behaviour (see section 3.7).
The HSC Monitor survey data trends strongly suggest that the SEAA (2003) impacted on the level of socially-cued smoking in various hospitality settings. This is plausible given that going outside to smoke may require interruption of indoor social activities and enduring
adverse environmental conditions (e.g. when the weather is poor and the facilities are poor). However, this impact may be eroded over time as hospitality venues provide more attractive and comfortable outdoor smoking areas (e.g. with seating and heating, and better protection from the weather). These results are consistent with the international literature suggesting socially-cued smokers are more likely to quit if there are smoking restrictions in social venues. (Trotter et al., 2002)
Evidence of impact on prevalence and consumption was, as expected, less clear. There was some evidence that smoking prevalence among year 10 students and their parents may have reduced following implementation of the SEAA (2003). However, as well as the problems of attribution described above, changes in student’s smoking prevalence may simply reflect the continuation of longer term trends, and changes in reported parental smoking may reflect the effects of changing accuracy of reporting and other influences.
Similarly, the effect of the SEAA (2003) on per capita consumption from the data on tobacco released into the New Zealand market was unclear. Interpretation is complicated by problems with fluctuations in the data described above, and the many other possible concurrent
influences on consumption. These include tobacco prices, affordability, media campaigns, availability of smoking cessation therapies, and media news items on smoking-related health risks. Overall there was no obvious effect of the SEAA (2003) observed in this data. The decline in quarterly tobacco sales data by supermarkets was consistent with an impact of the new law on the levels of consumption. However, the observed annualised rate of decline of 4.3% in supermarket sales following implementation of the SEAA (2003), was similar to the long-term trend in tobacco consumption in cigarette equivalents per adult New Zealander. This averaged a 3.2% decrease per year for the 10-year period from 1995-2004 and 5.2% per year for the 5-year period 2000-2004. (Ministry of Health, 2005c).
An issue that emerged from analysis of the Quitline data in relation to advertising spend promoting smoking cessation, was the apparent missed opportunity to maximise the impact of the SEAA (2003) on quitting behaviour. Introducing widespread restrictions on smoking in workplaces and public places was likely to have been an important trigger for smokers to quit. It would have made sense to increase the promotion of smoking cessation support and the availability of subsidised NRT through the Quitline, and to have ensured that Quitline had the resources available to deal with the increase in calls. None of this happened, and indeed
promotion of smoking cessation support was substantially lower in the six month period after implementation of the SEAA (2003).
In conclusion, the effects of the SEAA (2003) on smoking prevalence and consumption were not yet clear, and where there were observed reductions, these may have simply reflected the continuation of long-term trends. There was evidence of a reduction in socially-cued smoking – with smokers smoking less in key hospitality settings after the law change. There was also evidence that for a six-month period after the law change there were increased quitting-related behaviours (caller registrations with the Quitline and use of NRT).