All the focus groups worked well with a rich discussion and with good involvement of all participants. Results are presented for two main facets of the discussion – understanding of the TFC, and support for the Tobacco-Free Vision and establishing a TFC in order to achieve it.
Participants’ understanding of a tobacco-free commission
Most participants stated that they understood the TFC concept as presented.
“[It’s] a great idea, it’s clear and well presented.” (Māori non-smoker)
With further probing a few participants explained the idea back to the facilitator. For example, one participant compared it to the regulated nature of pharmaceuticals and hence restricted availability of these. Another more limited description of the model was:
“So people can still get tobacco, but it’s in a less in your face kind of way, it’s regulated to a degree.” (non-Māori non-smoker)
Participants usually stated that they understood the idea, but it was not possible in the time available to investigate if each participant could explain it back to the facilitator, so the depth of understanding could not be fully gauged. A hint that maybe the TFC was not fully understood by some came from one participant, who responded to a question to the group about whether they understood the TFC:
“It would be hard to explain it to other people.” (Māori smoker)
Support for the tobacco-free vision and tobacco-free commission
There was mostly strong support for the tobacco-free New Zealand vision among all groups of participants. The reason most commonly given for supporting the vision was to protect children.
“But for kids not to smoke I think is - it’s a great thing to bring in. I’d hate my kids to start smoking.” (non-Māori smoker)
Others supported the vision due to the need to reduce deaths caused by tobacco.
“I think it needs to be done. I think it’s necessary. When you look at the statistics of tobacco related deaths, it is-yeah, it is necessary.” (Māori smoker)
Two of the Māori smokers felt particularly strongly in support of the tobacco-free vision.
“Yeah. Just don’t fail. Just don’t. You know, make it work, make it happen.”
"“I also think too, we … have a responsibility to pass the message on to our families.”
Responses to the TFC idea were also generally positive although a lot of the support was expressed not as support for the TFC model and structure, but rather as support for specific measures which were mentioned in the presentation as among those which the TFC might facilitate, for example, plain (unbranded) packaging, licensing of and reducing the number of tobacco retailers, and removing point-of-sale retail displays:
“Definitely hiding them. Yeah, and making them de-labelled, is a good idea as well.”(Māori smoker)
“So I think the idea of getting smokes out of sight, and maybe restricting the amount of dairies, or - you know, things like that, dairies, plus close to schools, that would be good.” (non-Māori smoker)
“I like the idea of the plain packets of the cigarettes, and definitely handing out more information on its effects when people do buy it and that.” (non-Māori non-smoker)
“I think the packaging will make a – like it says, you’re drawn to certain designs and brands. And if it was all generic, I think given that, and putting it below eye level, there’s no real incentive, unless you really want to smoke”. (non-Māori non-smoker)
However, some did express strong and specific support for the TFC concept.
“Yeah, I support the idea. I wish this had come out years ago…” (Māori non-smoker)
Quitting smoking had changed the views of one participant.
“Well a year ago I wouldn’t have listened to this conversation, but now I do. I’ve given up smoking for six weeks. And I am glad I’m succeeding. Yeah, I agree with everything you said, I like that idea.” (Māori non-smoker)
Support also came from smokers who seemed committed to or resigned to continuing to smoke.
“I like the idea, but I know I’m cutting my own throat by agreeing with it. Because it’s working towards going against what I really really enjoy. But – so yeah, I think it would work. It’s a good idea.” (Māori smoker)
“I think it’s good, definitely a good idea…., you’re definitely not going to be able to stop smokers now, like people, … like us, but at least if you can do it, and make it happen, then you’ll stop other people from starting, you know. Like cos there’s just no hope for me.” (Māori smoker)
Again the reason for supporting the TFC approach was often brought back to the need to protect children from tobacco.
“I’ve got two young kids, I’d love them not to smoke…” (non-Māori smoker)
“I’d hate for my children to start smoking, or have to suffer like that – you know they get lung cancer …it’d (the TFC) be great.” (Māori non-smoker)
Another participant liked that the TFC would bring in stronger regulation whilst maintaining the choice of smokers to smoke.
“Well from a smoker’s perspective, they still get to smoke, if they choose to. From the Commission’s perspective, they get to re-educate and to regulate the supply of cigarettes, with the long term outcome being the reduction of smoking…. it’s sort of- everyone wins.” (non-Māori non-smoker)
Another liked the transparency and relative autonomy of the proposed TFC from government, retailers and from the industry.
“Well it’s a separate entity. It’s got no government influence, it’s got no influence from retailers … and from the tobacco industry … So therefore it is completely separate… it’s a- what do you call it, see-through, transparent.” (non-Māori smoker)
Participant’s concerns and caveats
In phase one of the “Daring to Dream Project”, the most commonly identified barriers for introducing a TFC identified by senior policy makers, journalists, and public health practitioners were the perceived political and ethical difficulties of a government agency selling tobacco or nicotine . The participants in this phase two study however, did not articulate this issue at all.
The most common concerns expressed related to the feasibility of establishing the TFC. Some participants noted that it would be vigorously opposed by the tobacco industry:
“…there’s tobacco companies. They’ve got so much power, so much money, they’re going to fight it tooth [and nail]…every step of the way.” (Māori non-smoker)
One participant argued that the tobacco industry would have to be neutralised in order to implement the TFC. Another questioned how the importation of tobacco could be controlled in practice. Several participants questioned the length of time needed to set up the TFC:
“Yeah, I mean how long is this going to take to actually get from here, to law, I mean that’s ten, twenty years, I don’t know.” (Māori non-smoker)
One participant questioned whether it could be achieved rapidly, and if not, whether it would be better just to implement some of the ideas discussed in the presentation like plain packaging, rather than putting energy into establishing the TFC.
Some participants argued that the key issue was whether the idea could be ‘sold’ to the government, one noted that selling the idea of an agency buying and selling tobacco was very radical.
“So you’re trying to market this to government … cos without government it’s not going to happen, is it? They’re the ones who’ll have to put some laws in place for it to happen, and you’ve got to sell that to the parties, different parties in parliament. The biggest message… the hardest one … will be the actual purchasing of tobacco. I can see … the plain packet stuff, that’ll be easy to sell that to the government. But the concept of trying to cut smoking by buying smoking [the smoking market] is a really out-there concept.” (Māori smoker)
“… if you can get the government to come forward, and help promote it, and support this, I think it can work – I believe it can work.” (Māori non-smoker)
Another set of concerns were expressed in relation to the structure and composition of the TFC. Several participants discussed the importance of getting the governance and membership right. For example, one Māori smoker felt that decisions about who was appointed as commissioners could become a ‘political game’ and that governance had to be sorted out before the operational arrangements. Other participants argued that it was important that members of the tobacco industry and politicians weren’t included and others argued that smokers should be:
“Yeah, you got to have a good group of people, from different – all areas, I mean you got to have smokers on it as well. Cos like non-smokers are sitting there going …smoking’s bad, blah blah blah, but … smokers… they’re the ones that are buy[ing] them, so you’re better to get their input as well.” (non-Māori smoker)
One participant noted that it was important that bureaucracy be kept to a minimum:
“Just, you know, keep your bureaucracy down to a minimum. Don’t make it another body that swallows our taxes.” (Māori smoker)
Another concern expressed in the non-Māori smoker group was that the TFC might result in an increase in the black market or home-growing of tobacco. One smoker argued that he would simply grow his own tobacco if it was no longer available for sale.
“It won’t worry me, cos at the end of the day, if they stopped it, and banned it, I’d just start growing my [expletive] own.” (non-Māori smoker)
Finally, some concerns were expressed by smokers, especially the Māori smokers, in response to the specific measures mentioned in the presentation that the TFC might introduce. The central theme was how specific measures might disadvantage them as an individual smoker. For example, several of the Māori smoker focus group participants held strong preferences for the brand they smoked and felt that brands tasted differently. Some were concerned that plain packaging would mean that they would not be able to identify their preferred brand, or it would no longer be available.
“People … don’t just go into the shop and buy like oh, any old crap, you know. You go in there and you know what you want.” (Māori smoker)
“So you know, if you’re going to de-label them, you’ve got to make sure that it’s still the same tobacco.” (Māori smoker)
Some smokers worried about the price of their cigarettes increasing, and argued that due to the simpler packaging, prices should fall instead.
“Oh, it’s a good idea. As long as it’s, you know, it’s not the price going up. That’s part of the price, the packaging. I mean that’s why you have no frills, and no brand.” (non-Māori smoker)