Annual Report 2018 - ASPIRE2025

PAGE FOURASPIRE2025 research teamThe ASPIRE2025 team– bringing great researchers togetherfrom many different backgroundsacross multiple organisations to helpachieve a Smokefree Aotearoa by 2025Co-DirectorsProfessor Richard Edwards (University of Otago, Public Health)Professor Janet Hoek (University of Otago, Public Health and Marketing)Andrew Waa (University of Otago, Public Health)Team MembersDr Jerram Bateman (Cancer Society Social and Behavioural Research Unit, University of Otago)Mei-Ling Blank (University of Otago, Marketing)Dr Tamlin Conner (University of Otago, Psychology)Professor Julian Crane (University of Otago, Medicine)Professor Chris Cunningham (Massey University, Te Pumanawa Hauora Māori Health Research Centre)Stephanie Erick (Hāpai Te Hauora)Dr Shelagh Ferguson (University of Otago, Marketing)Emeritus Professor Phil Gendall (University of Otago, Marketing)Dr Heather Gifford (Whakauae Research for Māori Health and Development)Dr Kerri Haggart (University of Otago, Marketing and Public Health)Dr Richard Jaine (University of Otago, Public Health)Dr Louise Marsh (University of Otago, Preventive and Social Medicine)Professor Rob McGee (University of Otago, Preventive and Social Medicine)Dr Rose Richards Hessell (University of Otago, Va’a o Tautai, Health Science)Dr Lindsay Robertson (University of Otago, Preventive and Social Medicine)Dr Dalice Sim (University of Otago, Biostatistical Services)Dr James Stanley (University of Otago, Biostatistical Services)Dr El-Shadan Tautolo (AUT University, Centre for Pacific Health and Development Research)Associate Professor Lee Thompson (University of Otago, Population Health)Associate Professor George Thomson (University of Otago, Public Health)Louise Thornley (University of Otago, Public Health)Maddie White (University of Otago, Public Health)Professor Nick Wilson (University of Otago, Public Health)Postgraduate StudentsJude Ball (PhD, Public Health, University of Otago)Grace Teah (PhD, Public Health, University of Otago)Julia Brillinger (Master of Public Health, Dept. of Preventive & Social Medicine, Dept. of Public Health)Madison O’Donnell (Master of Commerce, Department of Marketing)Marketing Administration and SupportFran Wright (University of Otago, Public Health)Sector PartnersASH New ZealandCancer Society of New ZealandHāpai Te Hauora Tapui LtdHealth Promotion AgencyQUIT Group

ASPIRE2025 ANNUAL REPORT 2018 PAGE FIVEProfiling some of our researchersDalice SimDr Dalice Sim is a Senior Research Fellow/Biostatistician at the University of Otago, Wellington,where her collaborations cover a wide range of activities on various medical and public healthresearch projects. Working with Richard Edwards and Jude Ball on smoking in adolescents usingthe ASH Year 10 Snapshot data, she has been investigating the differences in smoking rates andexposure to risk factors for smoking among adolescents from different Pacific ethnicities, as wellas investigating the impact of changing tobacco prices on adolescent smoking.Jerram BatemanDr Jerram Bateman is a Research Fellow in the Cancer Society Social and Behavioural ResearchUnit at the University of Otago in Dunedin. He is currently involved in projects exploring the saleand marketing of e-cigarettes in New Zealand; perceptions of tobacco retail reduction policies,and barriers to the implementation of the World Health Organisation’s Framework Conventionfor Tobacco Control in Sierra Leone.Kerri HaggartDr Kerri Haggart is an Assistant Research Fellow primarily working with Janet Hoek’s researchteam on the mixed-methods Marsden funded study: ‘Betwixt Two Worlds - Disruptivetechnology and negotiating identity change’. Kerri has also assisted on a number of otherASPIRE projects, including research on capsule cigarettes and tobacco product waste. In 2015,Kerri completed her PhD in cognitive literary studies, and her enduring interest in language anddiscursive psychology supports her current work in qualitative analysis.Grace TeahGrace Teah is a PhD candidate in Public Health at the University of Otago who is working underthe supervision of Professor Janet Hoek, Mei-Ling Blank and Dr Shelagh Ferguson on the mixedmethods Marsden funded study ‘Betwixt Two Worlds - Disruptive technology and negotiatingidentity change’. Her PhD is exploring the lived experiences of smokers and their transition fromsmoking to vaping. She has particular interests in how stigma and identity factors influence thistransition, and is exploring participants’ perceptions of their smoking and vaping practices.Julia BrillingerJulia Brillinger is a Masters student based in the Cancer Society Social and BehaviouralResearch Unit (SBRU) at the University of Otago, Dunedin. Her Masters research, supervisedby Dr Louise Marsh, Professor Janet Hoek and Dr Ella Losua, investigates the atmosphericattributes present within bar settings, particularly within outdoor smoking areas, thatmay influence smoking behaviours.Madison O’DonnellMadison O’Donnell is a Master of Commerce student in the department of Marketing at theUniversity of Otago, Dunedin. Her research, supervised by Professor Janet Hoek, exploresparticipant engagement with vaping culture and how vaping practices evolve. Her currentresearch continues this exploration with specific focus on novel and emerging ENDS devices.Update onMajor ProjectsAn update on the major projectsled by ASPIRE2025 researchersalready underway in 2018.

ASPIRE2025 ANNUAL REPORT 2018 PAGE SEVENPAGE EIGHTThe E-cigarettes and Informed Choice (EC-IC) studyBetwixt two worlds? Disruptive technology andnegotiating identity changeThe EC-IC study comprises three phases designedto examine how e-cigarette (now known as ENDS– electronic nicotine delivery systems) uptake couldbe promoted to smokers, who are likely to benefitif they transition from smoking to exclusive vaping,while minimising uptake among non-smokers.The Marsden-funded S2Vproject commenced in 2018and explores how people whosmoke manage different identitypositions as they transitionfrom smoking to vaping,continue smoking, or quitboth smoking and vaping. Thisintensive longitudinal qualitativestudy also provides uniqueopportunities to probe howparticipants’ wider perceptionsof smoking and vaping evolve.We have published two papers outlining findingsfrom the extensive qualitative phase – one examiningdual use practices, where people use both smokedtobacco and ENDS, and a second examininginformation seeking behaviours and how easilyparticipants locate information they seek. This latterstudy highlighted participants’ desire for disinterestedinformation on ENDS use and the likely benefits andrisks, and identified the difficulty they had in locatingthis information. In the absence of clear scientificinformation, many instead relied on word-of-mouthand commercial sources. We are currently workingwith the Health Promotion Agency, whose staff aredeveloping a vaping information campaign that shouldhelp address the knowledge gaps we identified.In partnership with Hāpai Te Hauora, we haveexamined factors that assist or impede ENDS useamong Māori and Pacific peoples who smoke.This work identified two overall challenges thatcomplicated movement from smoking to exclusiveENDS use. The first of these represented participants’search for satisfaction, including learning about ENDS,identifying and maintaining a device that would meettheir needs, and adapting to a new experience, whilethe second explored challenges faced when smokingremained normative within participants’ families andcommunities. Two themes identified factors facilitatinguptake and reinforcing transition: the liberation fromsmoked tobacco, and collective ENDS use.We have also examined perceptions of second-handvapour (SHV) and explored how these shape ENDSuse norms, which often diverge from second-handsmoke (SHS) norms. In particular, participants oftenbegan using their ENDS device inside their homesand cars, places where many had strict smoke-freenorms. Many used the lack of information about SHVand potential risks to others as evidence that SHV wassafe, and assumed there would have been campaignsor official advice if that were not the case. They alsointerpreted the lack of acrid after-smell and rapiddispersal of exhaled vapour as evidence SHV had noharmful constituents or, if it did, that it disappeared soquickly it could not harm those nearby.Further analyses are examining the role smokingdenormalisation plays in stimulating cessationattempts and participants’ experiences of stigma asboth smokers and ENDS users. Preliminary findingssuggest that, while the large aerosol clouds fromvaping devices appeal to some ENDS users, theyrepresent an unwanted visual signal to others.Phase 2 of the study examines perceptions andexperiences of vaping among smokers and susceptiblenon-smokers, estimates beliefs about ENDS useand studies the believability and credibility ofdifferent information messages that could promotetransitioning to ENDS among smokers while deterringuptake among non-smokers. We hope the findings willinform the Ministry of Health’s ENDS regulation, whichwill be introduced to Parliament later this year.Research teamJanet Hoek (PI), Lindsay Robertson, Mei-Ling Blank,Phillip Gendall, Rose Richards, Claire Cameron, PamelaLing, Lucy Popova, Louise Thornley.FundingHealth Research Council 16/149ASPIRE researchers: Lindsay Robertson, Janet Hoek, Mei-Ling Blank.We conducted a pilot study withtwo participants and recruited29 participants to the full 18-20week study, with 22 completingat least four of the five interviews.In a detailed initial interview,participants explained theirsmoking history, quit attempts,current smoking practices, andreasons for considering movingto vaping. They chose a vapedevice for use throughout thestudy (and beyond), and agreedto complete daily surveys on theirsmart phone that tracked howtheir smoking and vaping practicesevolved. Participants returned fora further four in-depth qualitativeinterviews at weeks 2, 6, 12 and18. Recruitment is continuingthroughout 2019, with 17participants commencing in Waves5 and 6.Several participants felt thereduced social acceptability ofsmoking keenly; they felt subjectto hostile looks and were awarethe lingering smell of smoking wasunattractive to others. Several feltcontrolled by smoking and theneed to factor smoking breaks intotheir day.Initial findings show very different transition patterns; while someparticipants made immediate, rapid and sustained reductions in smoking,others had longer periods of dual use and ‘sticky’ cigarettes that playedimportant roles in their day. Of participants who made full transitions tovaping, a small minority had quit vaping by the study’s conclusion, somehad reduced the number of vaping sessions they reported and others hadincreased the number of daily vaping sessions reported.Participants tended to adopt twodifferent approaches to vaping.Most began by viewing vapingas a functional strategy thatwould enable them to quitsmoking and had varyingbut generally low interestin flavours, tricks orthe social elements ofvaping. Several beganthe study openly criticalof people who vapedfor reasons other thansmoking cessation.However, during thestudy, some of theseparticipants changed theirperspective on vaping andbecame intrigued by the largeaerosol ‘clouds’ they emitted,practised vaping tricks, joined vapingcommunities, and purchased new and morepowerful devices. For these latter participants, vaping was no longersimply a means to an end, but a new and pleasurable activity.Most participants aimed to quit smoking and then quit vaping as theysaw this approach as the most beneficial to their health. However, thosewho found vaping enjoyable reframed this goal and saw their vapingcontinuing until some as yet undefined point.Preliminary analyses of the qualitative data show rapid changes inparticipants’ norms regarding second hand vapour. While nearly allmaintained smoke-free homes (and cars), most began vaping indoors andin cars, and saw the convenience and lack of after-smell as key factorsinfluencing these changing norms.Project teamJanet Hoek, Mei-Ling Blank, Tamlin Conner, Shelagh Ferguson, LeeThompson, Kerri Haggart, Grace Teah.FundingMarsden Fund 17/129

ASPIRE2025 ANNUAL REPORT 2018 PAGE NINEPAGE TENThe importance of tobacco to convenience stores:A national studyRYO-specific warning messagesTobacco’s widespread retaildistribution promotes smokingby making cigarettes moreaccessible, by making smokingappear normal, and byincreasing environmental cuesto smoke. The Government hascommitted to a goal of makingNew Zealand smokefree by2025 and greatly decreasingthe availability of tobacco itselfis a key aim.No jurisdictions use on-packwarnings targeting roll-yourown (RYO) use, even thoughRYO smokers may findquitting more difficult andbe at greater risk of relapsethan other smokers. RYO useis also increasing, with overhalf of all smokers in NewZealand reporting using RYOtobacco. Use is especially highamong Māori, young adults,and people experiencinglower prosperity. RYO-specificon-pouch warnings may bea cost-effective populationlevel strategy to increase andsupport cessation among thesegroups. The roll-your-ownstudy used a novel “constructa-pouch” elicitation method togenerate initial theme ideas andpreliminary designs for RYOspecific on-pouch warnings.Opposition from tobacco retailershas thus far impeded adoption ofpolicies to reduce retail availability.Tobacco is known to be a lowprofit product, yet retailers arguethat tobacco increases footfallin their stores and supportancillary purchases that increasetheir overall profit. While someresearchers believe that thisargument relies on misinformationdistributed by tobacco companies,only one published study hasexamined the validity of theseclaims. Post-purchase surveyswith customers in Philadelphia(USA), found that only 13% ofconvenience store transactionsincluded tobacco; most weretobacco-only purchases (8%) andonly 5% of transactions includedboth tobacco and non-tobaccoitems. Further, there was nodifference in expenditure on nontobacco items when purchasedwith or without tobacco.While these results are inconsistentwith tobacco industry argumentsthat tobacco is very importantto small retailers, replications ofthis study in a different regulatoryenvironment was important.We conducted an initial studyin Dunedin during 2017 andfound that the vast majority oftransactions at convenience stores (86%) did not include tobacco. Ofthe 14% of purchases that did include tobacco, 9% were tobacco-only.Purchases of tobacco with non-tobacco items accounted for just 5% oftransactions, and tobacco-purchasers spent no more money on nontobacco items than those who did not purchase tobacco. However, therewas considerable variation in the proportion of transactions that includedtobacco across outlets (range 1%–45%).We will undertake this study in a larger national sample size to providemore generalisable estimates and inform policies restricting the nationaltobacco supply. Following the methods used in our Dunedin study, wewill use immediate post-purchase surveys with customers when they exita sample of 50 convenience stores in urban areas of Wellington and 50stores in Auckland. The larger sample size will allow for some descriptiveobservations within the groupings (e.g., differences in tobacco salesbetween stores according to the deprivation level of the neighbourhood inwhich they are located).This study will provide novel and important information that informsmeasures to reduce tobacco availability, and will have national andinternational relevance. Reducing tobacco availability is considered a keycomponent of tobacco endgames, yet few jurisdictions have managed tolimit access to tobacco. This data will test the validity of retailers’ claimsthat tobacco sales are vital to their financial viability. Overall, our findings willinform policy development and community-led advocacy work aimedat reducing the supply of tobacco in New Zealand and achieving aSmokefree 2025.Project teamLouise Marsh, Robin Quigg, Claire Cameron, Mei-Ling Blank, Janet Hoek,Trudy Sullivan, Phil Gendall, and Lindsay RobertsonFundingLottery Health Research R-LHR-2019-101847In 2018, we conducted indepth interviews with 22 RYOsmokers using the “construct-apouch” elicitation method whereparticipants created their owntobacco pouch based on NewZealand’s standardised packaginglegislation. Participants chose avisual theme for their pouch bysorting through photos depictingdeath, regret, disfigurement,material hardship, financial loss,intergenerational transmission ofsmoking, harm to pets, chemicals/additives, and addiction. Textmessage themes included healthwarnings, regret, hope, harmto others, addiction, cessationefficacy, and chemicals/additives.Messages had both informativeand affect-arousing executions,including personal testimonials.Over half of our participants chose themes of death and regret depictingreal, identifiable smokers and personal, affect arousing, loss-framedtestimonials for their pouch. A minority of participants selected themes ofmaterial hardship, cost, harm to pets, and chemicals/additives. Virtually allparticipants dismissed health-framed, information-oriented themes andmessages, and many wove the design elements into a cohesive story thatreflected their personal circumstances. Almost none thought their mostrecently purchased pouch was more likely to prompt thoughts of quittingthan the pouch they created.We obtained detailed and rich responses even from participants with nodesire to quit or reading difficulties. Following the interview, over half ofthe participants gave unprompted feedback that they found the pouchconstruction task fun and interesting, suggesting this approach could beused to develop more cohesive warning narratives and a more holisticapproach to warning design.In 2019, we will use the findings from the qualitative phase to designeight pouches for an online survey of RYO smokers. Participants willrandomly view two of the eight pouches, and after viewing each pouchanswer questions about their affective, cognitive, and behaviouralresponses. Results will be available in late-2019.Project teamMei-Ling Blank, Janet Hoek, Phil GendallFundingUniversity of Otago Research Grant

ASPIRE2025 ANNUAL REPORT 2018 PAGE ELEVENPAGE TWELVETe Ara Auahi Kore (TAKe)New Zealand International Tobacco Control PolicyEvaluation Project (NZ-ITC Project)Smoking among Māoricontinues to be significantlyhigher than among Pākehā.There are significant gapsin knowledge about thedeterminants of smoking forMāori and the effectiveness ofcurrent cessation and widertobacco control measures. TheTAKe project was developedto help fill these knowledgegaps and inform policies andlegislation to achieve the 2025goal. The project comprisesthree studies: 1) a longitudinalstudy of Māori smokers, 2)focus group interviews withwhānau of smokers and 3)a survey of tobacco controlinterventions being delivered inTAKe study locations.The ITC NZ study (NZ-ITC), fundedby the Health Research Council,consists of a cohort of New Zealandsmokers and ex-smokers who arebeing followed up to see howtheir smoking related knowledge,attitudes and behaviours changeover time, what influences thosechanges, and to evaluate the role ofpolicy measures in promoting andsupporting quitting.Due to slower than expected participant recruitment for the Cohortstudy, the TAKe study timeframe has been extended by one yearand will conclude in mid-2020. At the end of 2018, three out of outsix locations were nearing completion of the Wave 1 recruitment forthe Cohort study. Interviews for the remaining three locations will becompleted by a research company working on behalf of our TAKe partnerorganisations in each location. At the end of 2018, the focus groupinterviews for the Whānau study had been completed, a draft technicalreport was being reviewed within the TAKe team and informationpamphlets were being prepared for dissemination to the Whānau studyand their wider communities. We expect publications from the Whānaustudy to be produced over the course of 2019. The methodology andprinciples underpinning th

Dissemination of ASPIRE research through sector and community engagementUniversity of Otago, New Zealand. 28 ASPIRE2025 research outputs 2018 34 ASPIRE2025 ANNUAL REPORT 2018 2018 Annual Report For the year ending December 2018 Me ka moemoeaa ahau, ko au anake Me ka moemoeaa e taatou ka taea e taatou If I am to dream, I dream alone