Ways in which Tobacco Promotion harms our children

1. The Paediatric Society of New Zealand, representing the child medical and health specialists of New Zealand, strongly supportsall the Provisions of the Smoke-Free Environments (Controls and Enforcement) Amendments Bill

2. In particular this submission focuses on the provision to prohibit point of sale displays of cigarettes and tobacco

3. Ways in which Tobacco Promotion harms our children • 1. Adult tobacco smokers are addicted, and product promotion or display of tobacco makes it hard for addicts to quit. • It is adult tobacco addicts who smoke around children – causing many thousands of ear infections, chest infections, asthma attacks and admissions to hospital in children. • It is those same adult smokers who provide role models for children to become tobacco addicts. Attempts to prevent teen uptake of smoking by education have been shown to fail while adults continue to smoke • 2. Tobacco marketing in convenience stores aims to promote tobacco directly to children as a normal everyday adult product, during their vulnerable early years

4. Pattermore, P “The Burden of Smoking-Related Respiratory Illness in Children”. In Trying to Catch our Breath: The Burden of preventable breathing diseases in children and young people. 2006

5. In Utero exposure • Estimates in recent years of 25-33% of pregnancies: • 14,000-19,000 NZ babies annually! • Significantly higher rates in young <25 years and Maori mothers

6. Proportion of Children 0-14 Years Living in a Household with a Smoker by Ethnicity and NZDep Index Decile, New Zealand at the 2006 Census Source: Statistics NZ via NZ Child and Youth Epidemiology Service

7. Youth uptake • Major risk factors (population attributable risks): • Parental smoking (22.9%) • Poor knowledge of adverse health effects • Smoking in the household • Availability and affordability of cigarettes • Smoking teenage role models on TV/film • Access to money; pocket money and income • In 2002: retail tobacco sales to 14-16 year olds was estimated to be >$18 million ($12.5million going to Government in taxes)

8. 24% Dairy 12% Service station 7% Supermarket 6% Vending machine Where do 14-16 yr olds get cigarettes? Darling H et al. Access to tobacco products by NZ youth. NZMJ 2005; 118 (1213).

9. Ways to help children • Adult smokers must be encouraged and helped to quit, especially in pregnancy and parenthood • Any form of tobacco promotion to adult addicts trying to quit must be removed • Any form of tobacco promotion to children and youth which normalises tobacco must be removed

10. Questions for the Tobacco Industry • Does the tobacco industry want to promote tobacco use to children and young people? • Does the tobacco industry use cigarette displays as advertising? • Are children influenced by cigarette displays?

11. In their own words “If you are really and truly not going to sell to children, you are going to be out of business in 30 years”. Liggett Tobacco Co. “Today’s teenager is tomorrow’s potential regular customer.” Philip Morris (Marlboro)

12. Rothmans NZ 1999 “You can’t sell if the consumer can’t see the cigarettes…you wouldn’t sell baked beans that way, so why sell cigarettes like that? Basic retailing principles hold that the product must be visible or it won’t sell.”

13. RJ Reynolds “Presence and creativity at point-of-sale [POS] are crucial to maintain consumer awareness since POS materials are the last exposure to advertising before product purchase” “Simply stated, the point-of-purchase is where the action is – it’s the retail environment. It’s a specific location in a store, it’s product display, and it’s in-store advertising. Importantly, and perhaps not so obviously, the point-of-purchase is also in the mind of the prospective customer.

14. Philip Morris “We’ve made the pack more appealing. We can do the same for your profits”

16. Evidence that cigarette displays affect children • Evidence is indirect, as direct comparison of smoking uptake among matched children exposed to displays vs no displays over many years is difficult to achieve • Children are able to name most of the cigarette brands displayed in their nearest convenience stores. Over 80% of children and young people recall tobacco displays in their local convenience store • Studies of the proximity to and number of visits to convenience stores show an increase in likelihood of smoking or considering smoking in the future • Exposure to point of sale displays has been found to be associated with susceptibility to smoking (possible intention to smoke) even in never smoking teenagers who have never purchased tobacco. • Evidence is summarised in Paynter & Edwards: The impact of tobacco promotion at the point of sale: A systematic review. Nicotine & Tobacco Research; 2009; 11(1):25-35

17. Effects of banning cigarette displays in Ireland July 2009 • Results • Immediately following implementation, compliance was 97%. • Support for the law increased among adults after implementation (58% Apr-Jun vs 66% Jul-Dec, p<0.001). • Recall of displays decreased significantly for adults (49% to 22%; p<0.001), more so among teenagers (81% to 22%; p<0.001). • There were no significant short-term changes in prevalence among youths or adults. • The proportion of youths believing more than a fifth of children their age smoked, decreased from 62% to 46%, p<0.001) • McNeill A, Lewis S, Quinn C, Mulcahy M, Clancy L, Hastings G, et al. Evaluation of the removal of point-of-sale tobacco displays in Ireland. Tob Control. 2010 Nov 18.

18. This issue is about: • A clever way of advertising a lethal product despite advertising bans • The portrayal to children of tobacco as a regular and normal adult product, alongside newspapers, confectionery, bread and milk • The visible temptation of tobacco to addicts trying to quit • Protecting those that cannot protect themselves – especially children.

19. Thank you

20. This issue is not primarily about: • the income and viability of traders. If our society’s small businesses are built on income from such a lethal product, that is a sad reflection of our society, and a situation that we must change. • In fact,removal of displays will not in itself stop tobacco addicts buying cigarettes, but it will decrease new custom and returning custom from those trying to quit. • preventing a blackmarket. The existence of lawbreakers is not a valid reason to avoid laws that protect the vulnerable. • In fact it is hard to imagine a blackmarket that caused as much ill-health, hospitalisation and mortality among its own clients as well as among the vulnerable childhood population as the tobacco industry does in its current operation.