This review aimed to identify the most recent scientific evidence for the effectiveness of major population-level tobacco control interventions and to consider the findings and their implications in a New Zealand context.
It was based on searches of the peer-reviewed scientific literature but with a particular focus on “systematic reviews” ie, Cochrane Systematic Reviews (CSR) and reviews by the US Task Force on Community Preventive Services (TFCPS). The focus on the interventions was generally limited to addressing immediate determinants of smoking and current smoking behaviour rather than more upstream causes
Methodology
Scope: This review focused on the evidence for effectiveness of major population level tobacco control interventions rather than those designed for specific individuals. The list of interventions was derived from the previous review [Wilson 2003] and with some additions agreed to in advance with Ministry of Health staff. The focus on the interventions was relatively narrow and generally was limited to the immediate determinants of smoking and current smoking behaviour rather than more upstream causes.
Consequently, the following intervention areas were not specifically addressed. These could potentially be considered in future reviews:
- Interventions to further reduce the upstream determinants of smoking such as poverty among low-income New Zealanders (socio-economic disadvantage is a risk factor for smoking initiation and for not being able to quit) [Wilson et al 2006; Fergusson et al 2007].
- Interventions to further enhance educational levels for children of low-income families (poor school achievement is a risk factor for smoking according to longitudinal data from New Zealand [Fergusson et al 2007].
- Interventions to further reduce income inequalities and unemployment levels.
- Interventions to reduce racial discrimination (given that there is New Zealand specific evidence around the association between such discrimination and smoking [Harris et al 2006a; Harris et al 2006b]).
- The impact of intensive combinations of the various interventions detailed in this review. For example, many of these interventions are likely to have synergistic effects.
- Interventions to increase the unpaid media coverage of tobacco-related matters.
- A complete re-design of the system for tobacco availability such as adopting non-commercial supply [Borland 2003; Callard et al 2005; Thomson et al 2005a]. Such considerations could build on US, Canadian and Scandinavian experience with national or state/provincial government control of alcohol distribution.
Key Results
The international literature reports high quality scientific evidence for a number of the population-level tobacco control interventions used in New Zealand. In many cases there is supportive New Zealand-specific scientific evidence for such interventions being effective. New Zealand policy-makers and health workers can be very confident in the scientific basis for major components of the current New Zealand tobacco control programme. Nevertheless, there remain some population level interventions for which the evidence-base is limited or insufficient and for which further research may be required before their appropriate role can be more accurately defined.