Richard Edwards and Janet Hoek suggest the next targets in the campaign against smoking should be dairies and other outlets selling tobacco products — as well as raising the purchasing age.

We applaud the Government's leadership in working towards the Smokefree 2025 goal, and, in particular, the continuing tobacco tax increases and progress on plain packaging.

Now is a good time to take stock and consider which future measures will help us achieve our world-leading smokefree goal.

A recent Herald editorial queried whether further tobacco tax increases, plain packs and enhanced health warnings will work. We believe there is strong evidence these will be effective. Since annual increases in tobacco taxation began in 2010, daily smoking has fallen from 21 per cent of the population in 2006 to 15 per cent in 2013 (and from 41 per cent to 32 per cent among Maori). Data from around the world shows graphic health warnings help prevent smoking and support quitting.

Plain packaging will see New Zealand warnings become substantially larger and thus more salient. Evidence from Australia clearly indicates that plain packaging is contributing to reducing smoking.


The Herald editorial also queried why a "stubborn few" smokers continue to light up. This question helps identify further actions to discourage young people from taking up smoking and encourage and help smokers to quit. We want to highlight four areas where we could, and should, be doing more.

First, tobacco is far too easily available; second, some social settings continue to support young people starting to smoke; third, greater investment is needed in smokefree campaigns and, finally, we could provide more quitting support.

Despite the terrible harm it causes, cigarettes are available from more than 5000 dairies, convenience stores, gas stations and supermarkets. Almost half of New Zealand's primary schools and over three-quarters of secondary schools have a retail outlet selling tobacco within a kilometre of their classrooms. Easy access to tobacco can also undermine quit attempts among smokers and increase relapse among those smokers who have managed to quit.

A retail licensing scheme could enhance enforcement of restrictions on sales to minors, reduce the number of tobacco outlets and create protected areas around schools. We could also follow the lead of two states and 154 towns and cities in the United States that have passed laws to gradually raise the age of purchase to 21.

Other actions would make it less likely for young people to slip into smoking in social settings. For many, occasional "social smoking" quickly turns into an addiction that can last lifelong. The risk is greatest in bars where young people gather; smoking is common there and judgment is often clouded by alcohol.

Making pubs and bars completely smokefree, including the outdoor areas, would greatly reduce the opportunities for young people to smoke socially.

Promoting smokefree behaviours through mass media, including television, print, radio, billboards and social media, is a highly effective way to illustrate health risks, reduce initiation and encourage and support quitting. We have a wonderful opportunity to extend our smokefree promotions so they meet internationally recommended exposure levels and achieve maximum impact.

Hard-hitting, well-resourced and sustained campaigns could illustrate smoking's disastrous health effects, provide advice, encouragement and support to smokers to quit, and raise awareness of New Zealand's Smokefree 2025 goal. These campaigns should be designed to reach groups with high smoking rates such as Maori, Pacific, young people and pregnant women.

We should continue to draw on new research and extend our excellent Quitline and face-to-face cessation support services, particularly so that these reach priority groups more effectively.

We also need to explore making new technologies to aid quitting more widely available - these may include e-cigarettes and new medications such as cytosine and nicotine inhalers.

These and other actions could address the reasons why young people continue to start smoking and many smokers find it hard to quit.

Reducing smoking will have huge health, social and financial benefits for smokers and their families and whanau. These will be greatest among Maori and Pacific communities, where smoking is most common. The economic benefits to New Zealand from increased productivity and reduced health care costs will be enormous.

Additional revenue from the next round of tobacco tax increases will be about $100 million a year and could fund the ideas we have outlined.

By tackling the reasons why some people continue to smoke, we can ensure that fewer young people start to smoke, more smokers succeed in quitting and that, by 2025, New Zealand is a place where the "stubborn few" who still light up will be very few indeed.

Next steps

• Make selling tobacco subject to a licence like alcohol.

• Restrict the number and location of licensed outlets.

• Allow no sales within a certain distance of schools.

• Raise minimum purchasing age to 21.

• Ban smoking in outdoor areas of pubs and bars.

• Give more help to quit.

Professor Richard Edwards is in the department of public health of the University of Otago at Wellington, and Professor Janet Hoek is in the university's department of marketing in Dunedin.