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Smoking and the census—need for an international consensus

Smoking and the census—need for an international consensus Public Health Unit, Tairawhiti District Health, Gisborne, New Zealand 5. White P. Enemies of the people. In Draper P, ed. Health through public policy. London: Green Print, 1991:92-100. Correspondence to: Mr Frank Houghton, Public Health Unit, Tairawhiti District Health, 141 Bright Street, PO Box 119, Gisborne, New Zealand. Fax: +64 6 867 8414; e-mail: FrankH@tdh.org.nz Commentary: David Hill Anti-Cancer Council of Victoria Even a cursory review of the literature on smoking reveals a mass of studies examining smoking rates among different population g roups. The importance of this information in helping to target and assess the effectiveness of anti-smoking programs is undeniable. Access to information on smoking rates is of equal impor tance to ecological studies examining the relationship between smoking and adverse health outcomes. However, the continual drain of such research must be assessed in the grim light of financial realities. This type of research competes against ever expanding demands for health treatment in an era of scarce (and in some countries reducing) health resources. In addition, such research needs to be justified in terms of its opportunity cost. However, actions in New Zealand could provide direction for the future on this issue. New Zealand has included a question on smoking in its census on several occasions, the most recent being 1996. This type of comprehensive data has facilitated not just a description of rates and trends, but also an e xamination of the social1 and socio-economic characteristics2 of smokers, an analysis of smoking in particular occupations3 and an exploration of contextual influences on smoking.4 A significant aid to the development of tobacco control policies inter nationally would be an international agreement by gover nments on the routine inclusion of questions on smoking in every census. This information would therefore be routinely available to health and health promotion researchers, freeing up their time and resources to focus in more depth on the development of effective prevention and cessation initiatives. This strategy would also routinely highlight the importance of this issue to both governments and the public. Other advantages would include the level of accuracy achieved, given the near complete coverage of the census in most industrialised countries, and achieving increased numbers of minority populations to facilitate in-depth analysis. One obvious concern for many people is that such information could be used by tobacco companies to increase sales. However, we have to accept that the ‘tobacco pushers’ 5, unlike their opponents, already have adequate sufficient resources to conduct whatever research projects they deem necessar y. Frank Houghton’ proposal for an inter national agreement to s oblige gover nments to include a question on tobacco use, as New Zealand has done in several censuses, raises interesting possibilities as well as some barriers that would need to be overcome. Of course, the ‘gatekeepers’ of the content of census questions set the bar for inclusion very high – they have to, or else the form would be too burdensome to complete. They also need to be careful to minimise questions that appear to invade personal privacy. However, New Zealand has shown that census authorities can be persuaded on these issues and that resulting datasets are indeed useful. For public health workers who want to champion inclusion of a question about smoking in their country’ next census, it might s be more strategic to bring money for the e xtra marginal costs to the census ‘table’, so to speak, rather than transfer the cost to the census – with the unintended implication that public health has better things to do with its money than conduct smoking prevalence surveys. At least in Australia, some of the data in the census may be obtained by proxy repor t from one member of the household, and this raises the possibility that proxy repor ts about smoking may not be reliable, and reliability of proxy reports may vary between cultures and cultural sub-groups. However, at least for adults in Australia, proxy reports yield almost identical prevalence estimates to those based solely on self-report.1 Although the proposal for an international ag reement about tobacco-use census questions is unlikely to be implemented at a prescriptive level, the World Health Organization’ Framework s Convention on Tobacco Control, which is currentl y being negotiated, offers hope of progress. The chairman’ text as it currentl y s stands contains clauses that would oblige signatories to collect prevalence data, and many countries might well see the census as an appropriate vehicle. Finally, adequate tobacco control is unlikely to be sustained on prevalence estimates obtained as infrequently as those provided by census. Therefore, they are most likely to be of value for validating estimates obtained from sample surveys, and for exploring patterns within sub-populations and associations with other variables the census is uniquely well-equipped to measure. References 1. Barnett JR. Does place of residence matter? Contextual effects and smoking in Christchurch. N Z Med J 2000; 113:433-5. 2. Borman B, Wilson N, Mailing C. Socio-demographic characteristics of New Zealand smokers: results from the 1996 census. N Z Med J 1999; 112:460-3. 3. Hay DR. Cig arette smoking by New Zealand doctors and nurses: results from the 1996 population census. N Z Med J 1998; 111:102-4. 4. Hay DR, Foster FH. The influence of race, religion, occupation and other social factors on cigarette smoking in New Zealand. Int J Epidemiol 1981; 10:41-3. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Smoking and the census—need for an international consensus

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Publisher
Wiley
Copyright
Copyright © 2001 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2001.tb00304.x
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Abstract

Public Health Unit, Tairawhiti District Health, Gisborne, New Zealand 5. White P. Enemies of the people. In Draper P, ed. Health through public policy. London: Green Print, 1991:92-100. Correspondence to: Mr Frank Houghton, Public Health Unit, Tairawhiti District Health, 141 Bright Street, PO Box 119, Gisborne, New Zealand. Fax: +64 6 867 8414; e-mail: FrankH@tdh.org.nz Commentary: David Hill Anti-Cancer Council of Victoria Even a cursory review of the literature on smoking reveals a mass of studies examining smoking rates among different population g roups. The importance of this information in helping to target and assess the effectiveness of anti-smoking programs is undeniable. Access to information on smoking rates is of equal impor tance to ecological studies examining the relationship between smoking and adverse health outcomes. However, the continual drain of such research must be assessed in the grim light of financial realities. This type of research competes against ever expanding demands for health treatment in an era of scarce (and in some countries reducing) health resources. In addition, such research needs to be justified in terms of its opportunity cost. However, actions in New Zealand could provide direction for the future on this issue. New Zealand has included a question on smoking in its census on several occasions, the most recent being 1996. This type of comprehensive data has facilitated not just a description of rates and trends, but also an e xamination of the social1 and socio-economic characteristics2 of smokers, an analysis of smoking in particular occupations3 and an exploration of contextual influences on smoking.4 A significant aid to the development of tobacco control policies inter nationally would be an international agreement by gover nments on the routine inclusion of questions on smoking in every census. This information would therefore be routinely available to health and health promotion researchers, freeing up their time and resources to focus in more depth on the development of effective prevention and cessation initiatives. This strategy would also routinely highlight the importance of this issue to both governments and the public. Other advantages would include the level of accuracy achieved, given the near complete coverage of the census in most industrialised countries, and achieving increased numbers of minority populations to facilitate in-depth analysis. One obvious concern for many people is that such information could be used by tobacco companies to increase sales. However, we have to accept that the ‘tobacco pushers’ 5, unlike their opponents, already have adequate sufficient resources to conduct whatever research projects they deem necessar y. Frank Houghton’ proposal for an inter national agreement to s oblige gover nments to include a question on tobacco use, as New Zealand has done in several censuses, raises interesting possibilities as well as some barriers that would need to be overcome. Of course, the ‘gatekeepers’ of the content of census questions set the bar for inclusion very high – they have to, or else the form would be too burdensome to complete. They also need to be careful to minimise questions that appear to invade personal privacy. However, New Zealand has shown that census authorities can be persuaded on these issues and that resulting datasets are indeed useful. For public health workers who want to champion inclusion of a question about smoking in their country’ next census, it might s be more strategic to bring money for the e xtra marginal costs to the census ‘table’, so to speak, rather than transfer the cost to the census – with the unintended implication that public health has better things to do with its money than conduct smoking prevalence surveys. At least in Australia, some of the data in the census may be obtained by proxy repor t from one member of the household, and this raises the possibility that proxy repor ts about smoking may not be reliable, and reliability of proxy reports may vary between cultures and cultural sub-groups. However, at least for adults in Australia, proxy reports yield almost identical prevalence estimates to those based solely on self-report.1 Although the proposal for an international ag reement about tobacco-use census questions is unlikely to be implemented at a prescriptive level, the World Health Organization’ Framework s Convention on Tobacco Control, which is currentl y being negotiated, offers hope of progress. The chairman’ text as it currentl y s stands contains clauses that would oblige signatories to collect prevalence data, and many countries might well see the census as an appropriate vehicle. Finally, adequate tobacco control is unlikely to be sustained on prevalence estimates obtained as infrequently as those provided by census. Therefore, they are most likely to be of value for validating estimates obtained from sample surveys, and for exploring patterns within sub-populations and associations with other variables the census is uniquely well-equipped to measure. References 1. Barnett JR. Does place of residence matter? Contextual effects and smoking in Christchurch. N Z Med J 2000; 113:433-5. 2. Borman B, Wilson N, Mailing C. Socio-demographic characteristics of New Zealand smokers: results from the 1996 census. N Z Med J 1999; 112:460-3. 3. Hay DR. Cig arette smoking by New Zealand doctors and nurses: results from the 1996 population census. N Z Med J 1998; 111:102-4. 4. Hay DR, Foster FH. The influence of race, religion, occupation and other social factors on cigarette smoking in New Zealand. Int J Epidemiol 1981; 10:41-3.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Oct 1, 2001

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