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Nick Wilson

Publications and source records attributed to Nick Wilson.

At least 37 records · Page 2Linked to original sources
PubMed2006

Population level policy options for increasing the prevalence of smokefree homes.

OBJECTIVE: To identify and evaluate the options for population level government policies to increase the prevalence of homes free of secondhand smoke. METHODS: The literature was searched for population level policy options and evidence on them. Three criteria were used to evaluate the policy options: effectiveness, the reductions on inequalities in secondhand smoke exposure, and cost effectiveness. The setting was four developed, English speaking jurisdictions: Britain, USA, Australia, and New Zealand. RESULTS: Evidence from all four countries shows some association between relatively comprehensive tobacco control programmes and lower prevalence levels of smoking in homes. The evidence of the effect of such programmes on inequalities in smokefree home prevalence is limited. No published evidence was found of the cost effectiveness of the programmes in achieving changes in smokefree homes. Within comprehensive programmes, there is some indirect evidence that some mass media campaigns could increase the prevalence of smokefree homes. Structural options that have potential to support smokefree homes include smokefree places legislation, and laws for the protection of children. CONCLUSION: The available evidence to date suggests that comprehensive tobacco control programmes (to reduce the prevalence of smoking in the total population) are likely to be the most effective and sustainable option for increasing the prevalence of smokefree homes.

Adolescent↗
PubMed2006

Observed smoking in cars: a method and differences by socioeconomic area.

OBJECTIVES: To establish a reproducible method to estimate he point prevalence of smoking and second-hand smoke (SHS) exposure in cars, and to compare this prevalence between two areas of contrasting socioeconomic status. METHOD: A method involving two teams of observers was developed and evaluated. It involved observing 16,055 cars in Wellington, New Zealand. Two of the observation sites represented a high and a low area of deprivation (based on a neighbourhood deprivation index) and three were in the central city. RESULTS: A 4.1% point prevalence of smoking in cars was observed (95% confidence interval (CI) 3.8% to 4.4%). There was a higher prevalence of smoking in cars in the high deprivation area relative to the other sites, and particularly compared to the low deprivation area (rate ratio relative to the latter 3.2, 95% CI 2.6 to 4.0). Of cars with smoking, 23.7% had other occupants being exposed to SHS. Cars with smoking and other occupants were significantly more likely to have a window open (especially if the smoker was not the driver). The observation method developed was practical, and inter-observer agreement was high (kappa value for the "smoking seen in car" category 0.95). CONCLUSIONS: Observational studies can be an effective way of investigating smoking in cars. The data from this survey suggest that smoking in cars occurs at a higher rate in relatively deprived populations and hence may contribute to health inequalities. Fortunately, there are a number of policy options for reducing SHS exposure in cars including mass media campaigns and laws for smoke-free cars.

Automobiles↗
PubMed2005

Secondhand smoke in New Zealand homes and cars: exposure, attitudes, and behaviours in 2004.

AIMS: To assess exposure to secondhand smoke (SHS) in New Zealand homes and cars and to describe attitudes and behaviours that relate to establishing smokefree settings. METHODS: In 2004, a nationwide telephone survey randomly selected and interviewed 2731 respondents. This sample was weighted to represent the national population and was comprised of a general adult population sample (n=1507), a sample selected from the Maori electoral roll (n=924), and a sample of current smokers and people who had recently quit smoking (n=300). RESULTS: 19.6% of the general population and 42.7% of the Maori sample reported current smoking. Of all current smokers, 47.2% smoked indoors at home and 70.8% smoked in their cars. Maori participants were significantly more likely to be exposed to SHS in their homes than non-Maori participants. There was also some evidence for lower socioeconomic status being related to higher SHS exposure. Extrapolating from the adult exposure data in households with children, it was estimated that 18.9% of children were potentially exposed to SHS indoors at home. However, most respondents (73.6%) lived in homes with total smoking bans. CONCLUSIONS: SHS exposure remains a significant problem especially for Maori and low-income New Zealanders. There is a need for further public health campaigns to increase the prevalence of smokefree homes and cars.

Adolescent↗
PubMed2005

Policy lessons from comparing mortality from two global forces: international terrorism and tobacco.

BACKGROUND: The aim of this study was to compare the mortality burdens from two global impacts on mortality: international terrorism and the major cause of preventable death in developed countries--tobacco use. We also sought to examine the similarities and differences between these two causes of mortality so as to better inform the policy responses directed at prevention. METHODS: Data on deaths from international terrorism were obtained from a US State Department database for 1994-2003. Estimates for tobacco-attributable deaths were based on Peto et al 2003. The countries were 37 developed and East European countries. RESULTS AND DISCUSSION: The collective annualized mortality burden from tobacco was approximately 5700 times that of international terrorism. The ratio of annual tobacco to international terrorism deaths was lowest for the United States at 1700 times, followed by Russia at 12,900 times. The tobacco death burden in all these countries was equivalent to the impact of an 11 September type terrorist attack every 14 hours. Different perceptions of risk may contribute to the relative lack of a policy response to tobacco mortality, despite its relatively greater scale. The lack is also despite tobacco control having a stronger evidence base for the prevention measures used. CONCLUSION: This comparison highlights the way risk perception may determine different policy responses to global forces causing mortality. Nevertheless, the large mortality differential between international terrorism and tobacco use has policy implications for informing the rational use of resources to prevent premature death.

Journal Article↗
PubMed2005

Implementation failures in the use of two New Zealand laws to control the tobacco industry: 1989-2005.

BACKGROUND: We reviewed the implementation of New Zealand laws in relation to the activities of the tobacco industry and their allies. Material for two brief case studies was obtained from correspondence with official agencies, official information requests, internet searches (tobacco industry documents and official government sites), and interviews with 12 key informants. RESULTS: The first case study identified four occasions over a period of 14 years where New Zealand Government agencies appeared to fail to enforce consumer protection law, although apparent breaches by the tobacco industry and their allies had occurred in relation to statements on the relative safety of secondhand smoke. The second case study examined responses to a legal requirement for the tobacco industry to provide information on tobacco additives. There was failure to enforce the law, and a failure of the political process for at least 13 years to clarify and strengthen the law. Relevant factors in both these cases of 'policy slippage' appear to have been financial and opportunity costs of taking legal action, political difficulties and the fragmented nature of government structures. CONCLUSION: Considered together, these case studies suggest the need for governments to: (i) make better use of national consumer laws (with proper monitoring and enforcement) in relation to tobacco; and (ii) to strengthen international law and resources around tobacco-related consumer protection. A number of options for achieving these aims are available to governments.

Journal Article↗
PubMed2005

Marketing fat and sugar to children on New Zealand television.

BACKGROUND: We aimed to determine the frequency and content of television food advertisements during children's viewing times on various New Zealand television channels. METHODS: A content analysis was conducted of two free-to-air channels covering a total of 155 h of television time during children's viewing times (n = 858 food advertisements in 2005). Comparisons were made with data from 1997 and data from Australia. RESULTS: Compared to Australian channels, both New Zealand channels (TV3 and TV2) had significantly higher proportions of food advertisements that were classified as being "high in fat and/or sugar" (54% versus 80% and 69%, respectively). Using a more detailed classification system, 70.3% of food advertisements on the New Zealand channels were for foods "counter to improved nutrition" (95% CI: 67.1%, 73.3%) compared to those "favoring improved nutrition" at 5.1% (95% CI: 3.8%, 6.9%). The number of food advertisements per hour was higher in 2005 than in 1997 for the channel (TV2) for which there was time trend data (12.8 versus 8.0 per hour for the afternoon time slot). CONCLUSIONS: These findings provide further evidence that the majority of food advertising on New Zealand television is counter to nutritional guidelines. They suggest the need for further regulatory or other controls.

Advertising↗
PubMed2005

Shifting dollars, saving lives: what might happen to mortality rates, and socio-economic inequalities in mortality rates, if income was redistributed?

Personal or household income predicts mortality risk, with each additional dollar of income conferring a slightly smaller decrease in the mortality risk. Regardless of whether levels of income inequality in a society impact on mortality rates over and above this individual-level association (i.e., the 'income inequality hypothesis'), the current consensus is that narrowing income distributions will probably improve overall health status and reduce socio-economic inequalities in health. Our objective was to quantify this impact in a national population using 1.3 million 25-59-year-old respondents to the New Zealand 1996 census followed-up for mortality over 3 years. We modelled 10-40% shifts of everyone's income to the mean income (equivalent to 10-40% reductions in the Gini coefficient). The strength of the income-mortality association was modelled using rate ratios from Poisson regression of mortality on the logarithm of equivalised household income, adjusted for confounders of age, marital status, education, car access, and neighbourhood socio-economic deprivation. Overall mortality reduced by 4-13% following 10-40% shifts in everyone's income, respectively. Inequalities in mortality reduced by 12-38% following 10-40% shifts in everyone's income. Sensitivity analyses suggested that halving the strength of the income-mortality association (i.e., assuming our multivariable estimate still overestimated the causal income-mortality association) would result in 2-6% reductions in overall mortality and 6-19% reductions in inequalities in mortality in this New Zealand setting. Many commentators have noted the non-linear association of income with mortality predicts that narrowing the income distribution will both reduce overall mortality rates and reduce inequalities in mortality. Quantifying such reductions can only be done with considerable uncertainty. Nevertheless, we tentatively suggest that the gains in overall mortality will be modest (although still potentially worthwhile from a policy perspective) and the reductions in inequalities in mortality will be more substantial.

Adult↗
PubMed2005

Directly eroding tobacco industry power as a tobacco control strategy: lessons for New Zealand?

AIMS: To examine some recent examples of tobacco control policies used elsewhere that seek to directly erode tobacco industry power, and to consider the relevance of these to New Zealand. METHODS: A literature search was supplemented with six key informant interviews, with World Health Organization (WHO) officials, and Canadian officials and advocates. RESULTS: The Provincial Government of British Columbia (BC) from 1997 to 2001 had an explicit objective of 'denormalising' the tobacco industry. Legal action was started against the industry to recover healthcare costs. The Canadian Government has been involved in defending its comprehensive tobacco control legislation in court against the industry since 1988. The policies to directly erode industry power, of both Canada overall and at the province level (BC), have been temporally associated with significant declines in smoking prevalence. Since 1998, WHO has conducted a series of inquiries into tobacco industry influence within WHO, and at regional and national levels. Its research and publishing focus on the industry has supported the creation of the Framework Convention on Tobacco Control, which has sections with the potential to assist national governments in strengthening strategies to erode tobacco industry power. The limitations of such strategies, and the uncertainties with using these approaches in the New Zealand context, suggests the need for careful planning and ongoing evaluation. CONCLUSIONS: Recent experience (in several jurisdictions and organisations) suggests that policies to directly erode tobacco industry power may contribute to the effectiveness of comprehensive tobacco control programmes. Some of these lessons could be incorporated into New Zealand's tobacco-control strategy.

Canada↗
PubMed2005

The contribution of smoking to inequalities in mortality by education varies over time and by sex: two national cohort studies, 1981-84 and 1996-99.

BACKGROUND: The contributions of tobacco smoking to overall mortality and socioeconomic inequalities in mortality vary between populations and over time. We determined how these contributions varied by sex and over time in two national New Zealand cohort studies. METHODS: Poisson regression and modelling were conducted on linked census-mortality cohorts for people aged 45-74 years in 1981-84 and 1996-99 (2.0 and 2.7 million person-years, respectively). RESULTS: Contribution to socioeconomic inequalities in mortality. Adjusting for current and former smoking reduced the all-cause mortality rate ratios for men with nil educational qualifications compared with men with post-school qualifications from 1.34 to 1.29 in 1981-84 and from 1.31 to 1.25 in 1996-99, or 16 and 21% reductions in relative inequalities. Equivalent results for women were 1.42-1.41 in 1981-84 and 1.42-1.37 in 1996-99, or 3 and 11% reductions in relative inequalities. Contribution to overall mortality. Using 1996-99 data, we estimated that if all current smokers quit and became ex-smokers, mortality rates would reduce by 11% for men and 5% for women. If everyone was a never smoker (i.e. a historically smoke-free society), mortality rates would have been 26% lower for men and 25% lower for women. CONCLUSIONS: The contribution of smoking to educational inequalities in mortality was greater for males, and increased over time for both males and females, reflecting the historically differential phasing of the tobacco epidemic by sex and socioeconomic position. Complete cessation of smoking in contemporary New Zealand would reduce both overall mortality and educational inequalities in mortality.

Aged↗
PubMed2005

The potential impact of the next influenza pandemic on a national primary care medical workforce.

BACKGROUND: Another influenza pandemic is all but inevitable. We estimated its potential impact on the primary care medical workforce in New Zealand, so that planning could mitigate the disruption from the pandemic and similar challenges. METHODS: The model in the "FluAid" software (Centers for Disease Control and Prevention, CDC, Atlanta) was applied to the New Zealand primary care medical workforce (i.e., general practitioners). RESULTS: At its peak (week 4) the pandemic would lead to 1.2% to 2.7% loss of medical work time, using conservative baseline assumptions. Most workdays (88%) would be lost due to illness, followed by hospitalisation (8%), and then premature death (4%). Inputs for a "more severe" scenario included greater health effects and time spent caring for sick relatives. For this scenario, 9% of medical workdays would be lost in the peak week, and 3% over a more compressed six-week period of the first pandemic wave. As with the base case, most (64%) of lost workdays would be due to illness, followed by caring for others (31%), hospitalisation (4%), and then premature death (1%). CONCLUSION: Preparedness planning for future influenza pandemics must consider the impact on this medical workforce and incorporate strategies to minimise this impact, including infection control measures, well-designed protocols, and improved health sector surge capacity.

Journal Article↗
PubMed2005

The smoking-mortality association varies over time and by ethnicity in New Zealand.

BACKGROUND: The strength of the smoking-mortality association may vary over time and by ethnic group. METHODS: Cohort studies of 1.6 million (1981-84) and 1.9 million (1996-99) New Zealanders aged 25-74 years were formed by the linkage of census and mortality data. Comparing current smokers with never smokers, standardized rate ratios (RRs) and rate differences (RDs) were calculated for all-cause and ischaemic heart disease (IHD) mortality. RESULTS: Between 1981-84 and 1996-99 the all-cause mortality RR increased from 1.59 (95% CI 1.53-1.66) to 2.05 (1.97-2.14) for men and from 1.49 (1.42-1.56) to 2.01 (1.91-2.12) for women. All-cause RRs were significantly greater among non-Ma-ori non-Pacific than Ma-ori: 2.22 (2.12-2.33) compared with 1.51 (1.35-1.69) in men and 2.20 (2.09-2.33) compared with 1.45 in women (1.27-1.66), respectively, in 1996-99. This RR heterogeneity remained after adjusting for socio-economic factors and was similar for IHD. The RDs demonstrated less heterogeneity. For example, in 1996-99 the RDs were 627 per 100,000 (452-802) for Ma-ori compared with 464 (427-502) for non-Ma-ori non-Pacific among men, and 368 (228-509) compared with 340 (311-370) among women. CONCLUSIONS: In New Zealand the relative effect of smoking on mortality differs over time and by ethnicity. We expect that such heterogeneity exists in other countries where the background mortality rates vary over time or between social groups. Information on this heterogeneity, including ethnicity-specific data, is needed to accurately determine the mortality burden owing to tobacco. The size of the RR estimates should be interpreted in the context of absolute mortality and effect measures.

Adult↗