Associate Professor Natalie Walker Tobacco control regulations in a country with a smoke-free goal (New Zealand) Associate Professor Natalie Walker

Disclosures Funding sources I receive contestable funding from the New Zealand government to undertake investigator-initiated smoking cessation trials Industry funding in last five years Cytisine and NRT provided at no cost VLNC cigarettes and e-cigarettes purchased Off label medication use Cytisine and e-cigarettes

1903: Juvenile Smoking Suppression Act Fined up to £10 if sold, gave or supplied youth under 15 years with tobacco Youth fined up to 5 shillings if caught publically smoking No conviction if had a medical certificate Women gained right to vote in 1893

NZ tobacco control legislation 1963 TV and radio ads banned 1974 Health warnings on packs 1990-2003 Smokefree Environments Act - No advertising, no oral use 2004 Smokefree workplaces 2007 Pictorial warning labels - 30% front, 90% back 2011 Endgame goal & smokefree prisons 2012 Counter display bans ??? Smokefree cars, plain packs [go thru list] Note that as a workplace, all schools and hospitals are smokefree Over the past three years the excise tax has increased by 40 %. Currently the average price of a pack of 20 cigarettes is US$12, while 25s is US$16 and a 30 gram pouch of tobacco is US$28. We are hoping for legislation around plain packs and smokefree cars very soon, and city bylaws to stop people smoking outside bars and restaurants

Cessation services in NZ 1980-90 Brief advice and counselling 1990s Nicotine patch in community pharmacies 1999 Quitline established 2000 Subsidised NRT via vouchers 2001 Health providers provide voucher 2005 NRT over the counter 2008 New cessation guidelines 2011 Health professionals monitored for delivery of ABC We have also had more than 25 years of smoking cessation support available, as shown here. I won’t read this out but of note is that we don’t have smoking cessation clinics, the government heavily subsidises the costs of smoking cessation medication, dual use of products is recommended in our treatment guidelines, and GPs and hospitals are required to provide evidence that the have asked every patient if they smoke, and if so, deliver brief advice and quitting support or referral for support. This information is published in national papers so you can see how your district is performing against others.. In addition a voucher system for NRT is standard practice. The voucher is used by Quitline and registered Quitcard providers to provide smokers with access to subsidised NRT. Smokers have to take the voucher to a pharmacy for redemption of product at a very low cost ($US2 for eight weeks supply). I will come back to the voucher system later

Price and duty-free allowance Annual 10% tobacco tax increases Price of 20 pack = US$14-18 (€13-17) Price of 30 gram pouch = US$37 (€35) Duty free allowance: 50 cigarettes, or 50 grams of cigars, or  50 grams of tobacco products, or  Mix of all three weighing not more than 50 grams [go thru list] Note that as a workplace, all schools and hospitals are smokefree Over the past three years the excise tax has increased by 40 %. Currently the average price of a pack of 20 cigarettes is US$12, while 25s is US$16 and a 30 gram pouch of tobacco is US$28. We are hoping for legislation around plain packs and smokefree cars very soon, and city bylaws to stop people smoking outside bars and restaurants

Regulation of e-cigarettes Medicines Act 1981* Smoke-free Environments Act 1990 E-cigarettes with nicotine No E-juice with nicotine Nicotine-free e-cigarettes Yes Nicotine-free e-juice * Advertising, selling and distributing if therapeutic claim made [Includes electronic shisha, electronic hookahs, pens or vapes etc]

Regulation of e-cigarettes Medicines Act 1981 Illegal to advertise an overseas website where nicotine- containing e-cigarettes or e-liquids can be purchased. Smoke-free Environments Act 1990  Illegal to advertise, sell and distribute e-cigarettes that look like a tobacco product (toy tobacco product) to people under 18 years of age.

Regulation of e-cigarettes People can import up to 3 months' supply of nicotine- containing e-cigarette products for their own use only. These can’t be supplied, sold or be given away to anyone else. The use of e-cigarettes in smoke-free places is not prohibited Aug-Sept 16: Public consultation. Awaiting response

E-cigarette use in NZ 2011 2012 2014 Smoking monitor 7% - (N=480, ≥ 18 yrs, current smokers recent quitters) 7% ever purchased - Youth insight survey (N~3,000, 14-15 yrs) Ever tried 20% Health & lifestyles (N=2594, >15 yrs) 13% Ever used 0.8% Current user* * Current users defined as “used at least once a day, week or month”

Use of e-cigarettes in NZ Misuse of Drugs Act 1975 Drug paraphernalia or utensils are illegal Defined as anything used as an aid to take drugs: includes vaporisers or repurposed e-cigarettes One year’s imprisonment, and/or a fine of up to $500. NZ National Drug Policy 2015-2020 “to minimise harm from alcohol and other drug use and promote and protect health and wellbeing.” Jul-Sept 16: Public consultation: do the drug utensil regulations support this policy? Awaiting response

Heat-not-burn products (Dec 2016) Battery-powered holder is legal Sale and distribution of the tobacco sticks (Heets) is prohibited under the Smokefree Environments Act No person shall advertise or “import for sale, sell, pack, or distribute any tobacco product labelled or otherwise described as suitable for chewing, or for any other oral use (other than smoking).”

Smoking prevalence in NZ 15 yrs and older, currently smoke, 2014/5 NZ census

Eight years to go! No roadmap Reduced tobacco supply Total ban Retailer licencing Retailer reduction Total ban Public support is strong No political will Election year

NZ tobacco control legislation http://www.health.govt.nz/our- work/preventative-health-wellness/tobacco- control THANK YOU