Health reporter Martin Johnston begins a series on the state of smoking in New Zealand and efforts to reduce it.
The number of teenagers who have never lit up a cigarette is rapidly increasing, leading some to conclude a sea change is occurring in young people's attitudes to tobacco.
Surveys for the Ministry of Health show that just over half of teenagers aged 15 to 19 have never tried smoking - "not even one puff". This is markedly higher than in 2006, when the figure was 39 per cent.
The trend, attributed to the increasing "denormalisation" of smoking through changes like the 2004 ban on smoking in bars, is even more marked among 14- and 15-year-olds. A survey of them in 2008 found that 61 per cent reported never having smoked - a figure that has nearly doubled in nine years.
The possibility of a radical shift in youth behaviour and attitudes to smoking coincides with a two-pronged push to plot the demise of tobacco.
The public health community and Maori Party MP Hone Harawira are campaigning for the eventual elimination of what they call an addictive poison that should no longer be considered a normal consumer product.
The National-led Government refused - in line with storekeepers' wishes - to implement the recommendation to put tobacco out of public view in shops. Yet it is convinced of the importance of reducing the smoking rate, so much so that it is holding district health boards to account on their smoking-cessation support to hospitalised smokers.
This is because smoking is so destructive - to individuals and to the economy. By causing serious illnesses like lung cancer, cardiovascular disease and other breathing and circulation conditions, it kills 4200 people a year, and secondhand smoke is estimated to take another 300.
And it costs the economy more than $1.6 billion, of which $1.5 billion is spent on healthcare.
Smokers spend about $1.6 billion a year on tobacco products, of which more than $1 billion is taken by the government in excise tax and GST.
Campaigning by the Maori Party has led to Parliament's Maori affairs committee deciding to hold an inquiry aimed at forcing the tobacco industry to reveal the methods it has used to promote smoking among Maori.
The committee is likely to recommend radical tobacco-control policies to the Government.
Smokefree campaigners such as Ben Youdan, the director of Action on Smoking and Health, are excited about the inquiry, which they see as a turning point in the history of smoking - and not just for Maori.
"This is a major opportunity to get tobacco manufacturers, who are the ones responsible for promoting tobacco and getting people addicted, to be publicly held to account.
"Traditionally, New Zealand has been a leader in tobacco control, for example banning advertising and introducing smokefree environments.
"Now we need to look at some of the end-game solutions for tobacco. The inquiry is a great opportunity to do that, to make tobacco a highly controlled product by 2020."
Maori Party co-leader Tariana Turia, who holds portfolio responsibility for tobacco control as Associate Minister of Health, last year put pressure on the Government by strongly suggesting that she favoured banning retail tobacco displays and increasing the excise tax, particularly on roll-your-own tobacco.
An acting deputy director-general at the ministry, Ashley Bloomfield, said discussions were ongoing with Mrs Turia and Health Minister Tony Ryall over displays, and a licensing regime for tobacco retailers was "on our radar".
He asserted that the evidence from the surveys of 14- and 15-year-olds was compelling, that youth attitudes and behaviour had swung firmly against tobacco.
Although the adult smoking rate, currently around 20 per cent, was declining only slowly, Dr Bloomfield said he was confident the youth change would flow through into a lower adult rate.
But Otago University marketing expert Professor Janet Hoek said the increasing proportion of never-smokers among young people did not automatically translate into reduced adult smoking prevalence.
She said the fact that smoking prevalence remained quite high among those aged 18 to 24 indicated the initiation age of smoking had simply been deferred because of the restrictions that applied to younger people.
Dr Bloomfield accepted there had been some deferral, but said the increase in youth who had never smoked was critically important.
"The longer you delay initiation the better, because they are less likely to take it up the older they get - once you get over 18 and get through those teenage years with their very strong peer pressure to try these things.
"In the past, 80 to 90 per cent [of smokers] have been addicted by the time they turn 18."
Smokefree Coalition director Prudence Stone said Ireland's retail display ban, introduced in July, had led to a sharp change in youth attitudes.
"They were asked to recall tobacco products on display. Their recall dropped dramatically, from 80 per cent before the ban to just over 20 per cent after. And less of them had confidence they could purchase cigarettes from a retailer after the ban."
Banning retail displays and applying progressive tax increases are key measures the Maori affairs committee will be asked to support.
Others include killing off tobacco brands, allowing tobacco packets to carry only generic text and health warnings, and capping the volume of tobacco released for sale, which would force up the price.
SMOKE TAX
Excise and sales tax as a percentage of retail tobacco prices:
* New Zealand 70 per cent
* Australia 62 per cent
* Canada 76 per cent
* New York City 77.4 per cent
* Britain 80 per cent
* France 80 per cent
(Source: Action on Smoking and Health.)
