Smoking causes death. There is a person who has seen it up close. In the 2000s, Verrall watched smokers come into the emergency ward every night, struggling to breathe with their damaged lungs. As an infectious disease specialist, she saw how smoking made people sick. She told them that quitting smoking was the best way to promote your health.
Verrall wants people to give up cigarettes by the thousands. New Zealand could become the first country in the world to achieve smoke-free status if she is successful in her plan. A traditional Mori name for the country is "Aotearoa". Chris Bostic, Washington, D.C.-based policy director at Action on Smoking & Health, says that a huge deal is about to happen. The policy will be the most comprehensive in history.
The plan was unveiled in December of 2021. The smoke-free generation strategy will prohibit the sale of tobacco products to people who were born in 2009. The goal is to create a group of people who don't smoke. Reducing the number of tobacco retailers would make cigarettes harder to get. Reducing the nicotine content of cigarettes is seen as the boldest proposal by experts. The head of the International Tobacco Control Policy Evaluation Project at the University of Waterloo says thiscuts right at the heart of why people smoke. It could be a game-changing change in the fight against smoking.
The importance of the measures is emphasized by Verrall. She says that it isn't a matter of one magic bullet fixing the problem. All are supported by science. She says that the effectiveness of denicotinization is proven. Research shows that reversing the clustering of tobacco retailers in poor neighborhoods will make it easier for people to stop smoking. Verrall thinks that the two strategies will get New Zealand to the smoke-free goal.
The measures will fuel an underground market according to skeptics. The plan is likely to fail due to a poor understanding of how it will work in practice. Although only retailers who sell and individuals who give tobacco products to those of the smoke-free generation will face penalties, critics think it will criminalize smokers.
The proposed law is going to be voted on by New Zealand's House of Representatives. It will take effect in January of the following year. The bill will pass according to advocates.
8 million people are killed by tobacco each year in New Zealand. It was one of the first countries to prohibit smoking in bars and restaurants. The taxes on cigarettes have gone up. The price of a pack of Marlboros in New Zealand is equivalent to $21. There are pictures of lung and heart problems in cigarette packages. Vaping has been shown to be an alternative nicotine source. One of the lowest smoking rates in industrialized nations can be found in New Zealand. The rate was about 12% in the US in 2020. Smoking-related cancer, stroke, and heart disease claim 5000 lives annually in New Zealand, and tobacco use is still the leading cause.
The Mori are more likely to smoke than the rest of the population. There is a big gap in health between smokers and non-smokers. For Mori, life expectancy is 73.4 years for men and 77.1 years for women, while for Europeans, it is 81 and 84.5. Mori have fewer of the social, institutional, and economic resources available to help them quit smoking because of the effects of colonialism and racism.
New Zealand's smoking prevalence has gone down due to strict restrictions on smoking and tobacco advertising. New Zealand could become the first country in the world to be smoke-free if legislation is passed in the near future.
Mori leaders believed in the mid-2000s that the solution to addressing inequalities was to get rid of tobacco. The anti smoking effort was launched in 2011. It aimed to reduce smoking prevalence to below 5% by relying on higher taxes, public education, and support for those trying to give up smoking through a toll-free Quitline. It was evident that more had to be done.
Nicotine is a compound that is as addictive as cocaine and heroin. Smokers feel a rush of pleasure when a cigarette drags nicotine through their bloodstream to the brain, where it causes the release of dopamine. The dopamine rush can also be triggered by other signals. According to Natalie Walker, a public health scientist at the University of Auckland, there are behavioral aspects to smoking. Nicotine has little to do with cancer. Tobacco smoke contains thousands of chemicals that cause diseases.
Nicotine increases the risk of hypertension and heart disease by damaging blood vessels and raising the pulse rate. Nicotine makes it hard for smokers to stop using cigarettes. People can't concentrate, anxious, or depressed when they quit cold turkey.
Since the 1990s, scientists have said that limiting nicotine in cigarettes might discourage smoking. The assumption is that if you reduce dependence and addiction, people will choose not to use tobacco.
There wasn't a lot of evidence to support that assumption. Walker launched a trial in 2009. She split New Zealand Quitline callers into two groups, one getting nicotine replacements and the other getting behavioral support calls from trained advisers. The majority of those in the second group reported a decrease in smoking urges. One-third of them reported not smoking at all in the prior week, compared with only 28% of the control group. The majority of those who received low-nicotine cigarettes said they would recommend them to others who wanted to quit. Walker and colleagues wrote in the March 2012 issue of Addiction that adding low-nicotine cigarettes to standard cessation support may help some smokers.
Congress gave the FDA authority to regulate nicotine in tobacco products if it isn't reduced to zero. Needing scientific evidence to guide regulatory decisions, the agency provided funding for studies and started to make cigarettes with varying levels of nicotine for research use. If you want to reduce nicotine in tobacco, you can either genetically modify the plant or treat the leaves.
A randomized trial that randomized smokers to receive cigarettes with standard nicotine levels or cigarettes with four different nicotine levels was conducted. All of the participants were lighting up more than usual. After 6 weeks, those given standard cigarettes were smoking more, 21 or 22 times a day, whereas groups with nicotine concentrations of less than 2 grams had reduced their daily habit to 15 to 16. One month later, one-third of those who smoked the lowest nicotine cigarettes were trying to quit, even though they had not previously intended to, and only one-fifth of those who smoked standard cigarettes were attempting to quit. Reduction of nicotine content in cigarettes could lead to less smoking, less nicotine dependence and improved public health according to a report in The New England Journal of Medicine.
People may just smoke more low-nicotine cigarettes to get their fix. He says the evidence shows that the concern is over. The data doesn't support that.
New Zealand has an anti smoking plan. People living near tobacco outlets smoked more and it was more difficult to quit. A model study based on New Zealand's demographic showed that cutting the number of tobacco retailers would drive down smoking rates.
It is hoped that the ban on tobacco sales to a new generation will be the third strategy. The idea has the approval of the parents. Marita Hefler is a tobacco control specialist at Charles Darwin University. It doesn't take anything away from people who are addicted to nicotine.
By the late 2010s, New Zealand researchers were able to present evidence to the government about what policies would make a difference. Verrall came up with a plan.
Verrall was a good leader from her early years as a student. The New Zealand Medical Student Journal was founded by her while she was in medical school. She was elected to the Wellington regional public health service's board in 2019.
She criticized the government's handling of the COVID-19 outbreak. She said in April 2020 that they needed a fire engine. The government expanded and sped up contact tracing and testing in order to keep case numbers low during the early stages of the Pandemic. Philip Hill, who was Verrall's thesis adviser at the time, says that she was the perfect person to engage the politicians.
Verrall gave interviews to newspapers explaining the importance of contact tracing. She is compassionate and cares about the health of New Zealanders. She was nominated for a seat in the House of Representatives by the Labour Party.
She was made a minister for research, science, and innovation. The smoke-free goal was put in charge of by Verrall. She says that it was the most bold and inspiring one she had ever heard of.
The action plan was unveiled in December of 2021. Walker says that the bundle of policies came through because of Verrall.
Verrall is considering New Zealand as a test bed. The smoking rate is already low. A majority of the public supports the goal of a smoke-free world by the year 2025.
Everyone is unhappy. Small mom-and-pop convenience stores calleddairies are likely to be hardest hit by the measures. An unnamed representative of the Dairy and Business Owners Group begged the lawmakers to delay the implementation of the plan until at least 2025.
The low nicotine cigarette policy will backfire according to others. British American Tobacco New Zealand warned that it would fuel a boom in the black market. According to a May 2020 report by the consulting firm KPMG for Imperial Tobacco, the amount of tobacco consumed in New Zealand is expected to increase. Bhutan banned the sale of tobacco products in 2004. Bhutan didn't offer cessation support or address tobacco use by adolescents. Michael Givel is a political scientist and Bhutan scholar at the University of Oklahoma. Bhutan stopped allowing tobacco imports in 2021. Antitobacco public education campaigns are being run by the government.
Nick Wilson is a public health scientist at the University of Otago. Wilson and his colleagues counted how many littered tobacco packs were foreign. Wilson says he "pretended to be doing up a shoelace" while also picking up packs. China and South Korea were the main source of foreign content. According to Wilson, most of the smuggled goods enter the country in shipping containers.
Control advocates think history is in their favor. Hefler says that once, smoke-free public places were not possible. In 1995 California made workplaces and restaurants smoke-free despite opposition. In 2004, Ireland became the first country in the world to prohibit smoking in public places. 67 countries have made public indoor spaces smoke-free according to the WHO. The pattern has been seen with health warnings. All of the innovations were followed by other countries.
They assisted. Between 1980 and 2016 the number of cigarettes smoked in the European and American WHO regions decreased. In WHO regions, cigarette consumption increased by more than half. The New Zealand plan appears to be the next logical step for advanced nations.
The United States is the only one that is considering nicotine regulation. The move to set a maximum nicotine level for cigarettes will be open for public comment in May 2020.
Bostic is worried that the tobacco industry will delay action in the US. He is more positive about the future. Beverly Hills and Manhattan Beach, both in California, halted all tobacco sales in January 2021. Bostic says that smokers can go to neighboring towns to buy something.
A number of countries are studying tobacco-free generation policies. The idea of a tobacco endgame is being taken very seriously.
New Zealand is leading the way. Verrall says they'll be happy to share their experience.
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