Aiming for clean, green and tobacco-sales-free

OPINION: Four out of five Kiwi smokers would not smoke if they had their lives over again, says researcher Marewa Glover.

Banning the sale of tobacco products by 2020 seems to be a done deal. The Maori Affairs select committee examining tobacco harm appears to be genuinely looking for ways to make it happen. The potential barriers to a ban appear to be the erroneous claim that an illicit trade would thrive driven by demand, and concern for smokers unable to stop by the time a ban on sales comes into effect.

It is clear that the main argument for banning the sale of tobacco products is to reduce the high rates of death and disease that result from smoking. There are about 656,000 smokers in New Zealand and if they continue to smoke, half will die as a result and many more will suffer smoking-related illnesses.

If the sale of cigarettes is banned in 2020, as is being discussed, the questions that remain are how many current smokers will quit by that time, how many will be satisfied to switch to alternative nicotine- delivery products, and how many will still want to source tobacco for smoking.

The demand for tobacco is already in decline. Four out of five smokers would not smoke if they had their life over again. Twenty-six per cent of current smokers want a ban on sales, increasing to nearly 50 per cent if non-tobacco nicotine substitute cigarettes are available. One third of smokers try to quit each year, however, the power of their addiction means that there is an annual reduction in smoking prevalence of less than 1 per cent.

At the present rate of decline, unless we take radical measures, we can estimate that the prevalence of smoking by 2020 will still be 17 per cent. There is a high rate of relapse to smoking because of the addictive power of nicotine and the many triggers that overpower the motivation to stay smoke-free. Once a ban is in place many of these triggers, such as exposure to tobacco marketing in dairies and petrol stations and to other people smoking, will be removed or significantly reduced.

In the interim, if we progressively reduce the amount of nicotine in cigarettes, the severity of nicotine addiction by 2020 will decline to levels that make sustained quitting more possible.

New nicotine-delivery products are being developed all the time. Provided that these products are available for sale in New Zealand, smokers will have a wide range of alternatives available to them in the next 10 years. New treatments for nicotine addiction are also promising, for example, a vaccine is in development.

Improved access to stop-smoking support and treatments, especially for women of child-bearing age and parents of young children, will stem the flow of new smokers. Fewer parents smoking will mean fewer children taking up the habit.

In fact, whatever the outcome of the proposed ban on tobacco sales, we need to shift prevention efforts to focus on women of child-bearing age and those who smoke during pregnancy. Focusing on Maori women is particularly important because of their relatively high rates of smoking.

Preventing smoking during pregnancy would almost eliminate sudden unexpected deaths in infancy and would reverse the trend toward more and more of these deaths happening in Maori families. It would also reduce rates of lower respiratory tract infections and ear infection in children and reduce the severity of child asthma.

It has been suggested that a tobacco sales ban could reduce the prevalence of smoking to about 1 per cent or 32,000 people. By helping people to quit in all of the ways I have described, the number of people who would still want to smoke would also be reduced.

Because the proposed ban stops only the commercial sale of tobacco - which is not the same as prohibition - smoking as a behaviour will not be illegal. People who want to continue smoking tobacco might try growing and curing their own, or obtain it from overseas. A small percentage of New Zealanders might buy from illicit sources, although presumably the excessive prices would put many off.

* * *

As we've seen with progressive law changes banning smoking in workplaces, schools, restaurants and pubs - public support grows for extending smoke-free environments. With so few people smoking, social smoking would become highly unacceptable, meaning that even more people would be encouraged to stop.

Even if 1 per cent of adults continue to smoke, only half of them, about 16,000, will die from cigarettes compared with about 16 per cent at present.

Soon after cigarette sales stop in 2020 we expect to be able to postpone up to one in six funerals by anything from one to 40 years of extra life, and that people will be living with less cancer, coughing, wheezing, and ill health.

A sales ban will save lives and prevent premature deaths without making criminals of those who wish to continue smoking. Most importantly, our children will live longer and healthier lives once New Zealand is tobacco-sales-free.

Marewa Glover is director of the Centre for Tobacco Control Research at Auckland University. She presented an oral submission to the Maori Affairs select committee.