Addressing Smoking Among Young People in New Zealand - A Study of Youth Smoking and Smoking Cessation

Introduction Reducing the prevalence of smoking in New Zealand is a priority, whereby greater reductions are required amongst Māori relative to non-Māori in order to reduce widening health-related disparities associated with smoking. To date, there has been no comprehensive New Zealand specific research conducted on youth quitting behaviour to inform how youth-specific policy for cessation could be developed to effectively address cessation amongst this age group. The aim of this research was to study youth smoking and cessation in New Zealand, relative to adults. Seven research questions were set to investigate this aim: 1. Is youth smoking a public health problem in New Zealand? 2. Do youth have dependence on nicotine? 3. Do youth demonstrate motivation to quit smoking? 4. Do New Zealand youth make attempts to quit smoking? 5. What services and support do New Zealand youth use to quit smoking, and do they work? 6. What further insights are needed to progress current understanding of smoking cessation among New Zealand youth? 7. For all the questions outlined above, what are the differences between Māori and non-Māori? Methods Two systematic literature reviews and four studies were undertaken to investigate the research questions above. Three studies were conducted using four robust quantitative data sources including the New Zealand Census of Population and Dwellings (1996-2006), the New Zealand Tobacco Use Survey (2006), The Quitline caller database (2006-2008) and the Quitline service evaluation (2006). One exploratory study was conducted to investigate the feasibility of conducting research with Māori in schools, using qualitative research methodologies to identify information gaps highlighted in Studies 1, 2 and 3. Results The results demonstrate that smoking is a public health problem in New Zealand among youth and young adults, with the highest smoking prevalence (29.8% in 2006) noted among 20-24 year olds. Among Māori aged 20-24 years in 2006, the prevalence of smoking was 50.3%, compared to 27.6% among non-Māori. The results indicate that smoking initiation mostly occurs between 16 and 20 years in New Zealand; however Māori continue to initiate smoking significantly earlier (under-15 years) than non-Māori youth. Findings provide evidence that youth demonstrate dependence on nicotine and some motivation to quit smoking. However, the results highlight limitations in using adult derived tools to assess nicotine dependence and motivation to quit smoking among youth, as these concepts are likely to be defined, understood and experienced differently among youth compared to adults. Findings demonstrate that in 2006 the ratios of ex-regular to regular smokers among Māori (youth=0.17; young adults=0.23; adult=0.55) were lower than non-Māori (youth=0.27; young adults=0.42; adults=1.40). Furthermore, findings demonstrate that the rate of Quitline callers per 1000 NZ regular smokers among non-Māori youth and young adults was approximately 50% higher than Māori youth and young adults in 2006, OR=1.56 (95%CI=1.54, 1.58); 2007, OR=1.50 (95%CI=1.48, 1.52); and 2008, OR=1.44 (95%CI=1.42, 1.46). Moreover, preliminary qualitative evidence indicates that Māori youth were less aware, and knowledgeable of, available cessation options to use to help them quit smoking. Generally youth and young adults demonstrated lower annual quit rates (15-24 years=21.8% (95%CI=18.2, 24.7), compared to adults (25-64 years=32.6% (95%CI=31.0, 34.1) who had used the Quitline service. Conclusions The findings presented in this research highlight that youth and young adult smoking should be considered a significant public health problem in New Zealand. While prevention initiatives to date appear to have been relatively successful in driving smoking prevalence down among 14 and 15 year olds, the prevalence of smoking is still high among older youth (16 to 24 years). This suggests that review of prevention policy and approaches for New Zealand youth and young adults is needed. Prevention approaches could be focussed better towards Māori youth earlier (under 15 years) and towards Māori and non-Māori youth aged 16 to 20 years. The findings highlight numerous research, policy and service implications. Importantly, the findings emphasise that while prevention of uptake is important, the value of investing in cost-effective cessation services for youth could be valuable for driving the prevalence of smoking down, particularly among Māori. Increasing optimal quit attempts among youth could be achieved by improving communication and marketing of available cessation options to this age group. If the provision of effective cessation services and or a strategy could contribute to decreasing health inequalities observed between Māori and non-Māori, this could potentially be a key component (as part of comprehensive tobacco control initiatives) to ending the tobacco epidemic in New Zealand