"Public support for stronger policies could strengthen political will; however, little is known about how smokers perceive endgame scenarios ..."
The tobacco companies are cornered.
They have spent millions on advertising campaigns opposing plain packaging, and have taken court action in a high-stakes attempt to stop its implementation.
They are buying up electronic cigarette brands: if you can't beat the quit smoking brigade, buy 'em out.
They have hired some of the best-connected lobbyists in Wellington to whisper in the ears of politicians, and, in at least one documented case, have made cash contributions to a political leader's expenses.
Why so feral? It is because New Zealand is on track to become the first country in the world to vote to ban the sale of tobacco, and to stamp out its consumption in workplaces, public spaces and even - as the Herald on Sunday reveals today-private places like the family car.
Smokefree New Zealand is an ideal that, if successful, will have been more than 40 years in the making - but it faces a massive hurdle.
With 2025 edging closer, there are still around 650,000 New Zealanders - 18 per cent of the adult population - who continue to smoke.
In Gisborne, restaurateur Lee Fong stopped selling cigarettes six years ago. The owner of the China Palace saw the impact smoking was having on her customers and it troubled her.
"A lot of parents were spending a lot of money on smokes and were having problems looking after their own children."
She has not missed the cigarette revenue and, with the aid of nicotine replacement therapies, now boasts a 20-strong smokefree workforce.
People like Lee Fong are making a difference at a local level - but nationwide public health strategies to eradicate smoking will affect every New Zealander, not just the smokers.
Taxpayer dollars are being thrown at targeted mass media campaigns, generously-subsidised quit smoking products and wrap around support agencies. At the same time law makers are changing the legislative landscape as they strive to make smokefree environments the new normal.
The task of such wholesale change to social attitudes is both unprecedented and challenging but the cost, say those at the forefront, is worth it. You see, this is a matter of life and death.
The following 10 strategies will stub out smoking in New Zealand.
1. Smokefree cars
When Lisa's baby was born her car became strictly off limits to cigarette smoke.
But now her daughter is a little older she admits the same rules don't apply anymore.
"I do smoke in the car now but not when she is in there. I do have all the windows down a bit, though. Second-hand smoke is terrible."
She's not wrong, says Professor Janet Hoek, a leading tobacco control researcher from Otago University.
There is good evidence children exposed to second-hand smoke in cars have increased risk of chest infections, glue ear, childhood asthma, and sudden infant death syndrome.
Associate health minister Tariana Turia reveals she intends to pass a law to ban smoking in cars with children before she retires next year.
2. Slashing supply
Three months ago the unthinkable happened at the remote Otira Hotel. Over the course of a weekend the cigarette supply sold out.
What happened next was surprising: The townsfolk started renouncing years of smoking and quit.
Says hotel owner Christine Hennah: "The people got fed up with driving further out to get their smokes and many quit."
For Hennah, it's been three months now since her last puff.
Auckland University researchers are about to undertake a groundbreaking feasibility study of dairies to see if making cigarettes harder to purchase will help people quit. But they need only ask reformed smoker Hennah: "I think it does," she says.
3. Plain packs
Palmerston North dairy owner Dakshina Keshav thinks the switch to plain packaging for cigarettes is going to be more trouble than it's worth.
"For people who are selling cigarettes and tobacco, it's going to be a hassle."
Keshav is doubtful it will put people off smoking.
"Whether the package is colourful or not, the cigarette tastes the same."
So far Australia is the only country in the world to introduce plain packaging, but it is facing a legal challenge by tobacco companies.
The New Zealand Government is keeping close watch on how that unfolds before legislating along similar lines.
4. Smokefree communities
A student is on a break between classes and needs a smoke. The trouble is, last month Auckland Council slapped a citywide smoking ban on all parks, community facilities and transport hubs.
It's part of a bigger five-year trailblazing plan that will see the ban extended by 2018 to shared public spaces.
But that's lost on long-time smoker Sally O'Brien. She plans to ignore the ban and has no qualms smoking in the newly-designated smokefree spaces.
"I'll carry on smoking and it will be up to them to enforce it.
At some stage I'm bound to get fined but I'll just accept it."
It's the price she's prepared to pay for her freedom.
5. Cutting duty-free tobacco
Last week the Herald on Sunday revealed ministerial plans to cut the duty-free concessions on tobacco this year.
Within months the Cabinet will decide whether all or part of the existing 200 cigarette limit is to be removed when travellers arrive in New Zealand. Options include removing the concession entirely, limiting travellers to one open packet, or allowing up to 50 cigarettes like Australia.
The announcement has been met with alarm from the tobacco industry but tobacco control researchers are thrilled. Tala Pasifika programme manager Stephanie Erick says: "The majority of New Zealanders want to be smokefree and are prepared to do what it takes to create a future legacy for our children."
6. Tax hikes
Smoker Kathy finishes her cigarette, drops it on the road and stubs it out with her foot. "I think smoking is a big killer but so are vehicles and lots of other things.
If you look at ACC and back injuries why aren't we banning people from playing sport?"
The Auckland woman, who does not want to give her surname, says the Government is unfairly targeting smokers in the pocket.
But public health researchers and anti-smoking advocates say hitting the pockets of smokers has a strong effect on tobacco consumption and quitting.
"Tax increases really drive more people to make more quit attempts so we know that works," says Quitline's Paula Snowden.
Kathy's not interested. She knows it's killing her, but says she's prepared to pay an ever higher price to maintain a lifelong habit.
7. Mass media shock tactics
All Black Piri Weepu splashes down a giant water slide. Adrian, suffering terminal oral cancer, lets us see his final days on earth.
These are among the faces fronting anti-smoking campaigns that have persuaded many to stay away from cigarettes, and form a sweeping national strategy to "denormalise" tobacco.
Quitline says the ads work: There is a sudden increase in phone calls to the 0800-linewhen they go to air. Health Promotion Agency tobacco control manager Kath Blair says a new campaign is on the drawing board for next year targeting young adults who smoke.
8. Removing all flavour enhancers
It's odd to think that using your body as a chimney could actually taste nice.
But that's exactly how tobacco companies lure new, young smokers - by disguising the taste with a menthol flavour and masking what would normally be an unpleasant experience.
According to overseas and local research, the menthol flavour is particularly popular among poorer communities in both America and New Zealand.
ASH and the Smokefree Coalition want the Government to remove all flavours and additives, saying if they weren't in cigarettes fewer people would take up smoking.
9. Booting out the lobbyists
In the past, when the tobacco industry stomped the corridors of power in Wellington, health workers trembled.
Despite New Zealand being a signatory to the Framework Convention on Tobacco Control, ASH says the tobacco industry's dealings with all government departments are less than transparent.
The Ministry of Health publishes a short public summary of any meeting with tobacco lobbyists, including a list of attendees, in accordance with Article 5.3 of the convention. ASH hopes other ministries, whose meetings are shrouded in secrecy, will follow the health ministry's lead.
10. Quit smoking support
Kelly Pohatu celebrated a major milestone this week. It's been a year since the 27-year-old west Auckland communications advisor signed up to Wero's stop smoking challenge and she hasn't lit up since. "I'm still a non-smoker to thisdayandI'mvery proud of it."
At Quitline, it's possible to quit smoking for a fraction of the price of a packet of cigarettes.
For $5 quitters are given an eight-week course of a recognised nicotine replacement therapy and offered advice and online support to end their habit.
The Ministry of Health-funded service trumpets a high success rate of 24.2 per cent of people quit at six months, but Snowden admits the average smoker may take up to 13 attempts.
