Hello I'm a researcher with the University of Auckland and the Cancer Society. We do a lot of work with Auckland Council. The census cigarette smoking data available at local board level is invaluable for our work in each community. For example, Auckland Council has set its own Smokefree 2025 target for the Southern Initiative region (3% prevalence by 2025). It is only census data that will give Auckland Council and all those concerned with health in that region an accurate and useful gauge of how we are progressing with the target for all populations in this area. Having the ability to cross tabulate data is particularly important for ensuring that inequalities in smoking rates, which currently exist for Māori and Pacific peoples, are eroded.
The health survey isn't fit for this purpose.

Hi All
I’m Penelope Scott , Health Promotion Manager Cancer Society –Otago and Southland Division. Please retain the cigarette smoking question in the census. We need detailed data. Smoking still kills around 5,000 kiwis per year and having detailed data in a large region like Otago and Southland where there are many different types of communities is very helpful.

Hi I think the cigarette smoking question is a good one and the long time it has been collected is great. It is a good way to keep the pressure on government to tackle this issue.

Please keep the smoking question in - for all the reasons above - but could you add e-cigarettes too please? We have no real handle on their use, and whether this has the potential to undermine the smokefree message (including encouraging youth experimentation as shown in a recent NZ study), rather than them being a quit aid.

I personally find the level of anti-smoking discussion in this thread distasteful and it appears this has become a rather partisan thread

Hi @maxdilloncoyle . I suppose since this variable is primarily used by the health sector and is under the topic of health the discussion does tend to be coloured by that. If you would like to provide an alternative point of view then you are very welcome to do so :)

Tobacco smoking helps to subsidise our health system with all smokers paying not only for their healthcare but also the healthcare of another kiwi. Great to know how many people are helping keep our health system going and how much tax we can expect from these good people.

Hi guys, just an update for those who are interested in data substance consumption besides tobacco. The Health survey run by the Ministry of Health now collects the data on drug and substance use that used to be collected in the survey that @lifengzhou1 linked to earlier. Does this fill the need for information on substance consumption?

Hi Tom and others.
In reponse to your point above, the health survey (while capturing other substance use) does not have the end touch/reach of a National Census and as relfected above by the using professionals is viewed as an invaluable data tool around smoking beahviours.
I tend to agree with all of the above that keeping the cigarette question in the census has clear benefits, but like Max, would suggest there clear opportuities to extend to other (legal/illegal) drug use (Alcohol in particular).
I would also suggest (and I accept the delicate non- intrusive and national social benefit mandate of the census) that there are a number of wider health/diet related questions that could be covered by the census and of value in informing and guiding policy/treatment.

No it does not fill the need, if it did it would render the cigarette smoking question useless also as that is included in the MoH survey. So either include drugs or remove both.

I think it is not advisable to include in the census questions that, if answered truthfully, indicate the person is breaking the law. Questions about use of unlawful drugs may jeopardise participation and completion rates, and so bring other census results into question. Some people still suspect that authorities such as police have access to the census data and may come knocking. We know they don't, but some people are worried about that.
As Lifeng said, separate Alcohol & Drug surveys can collect more detail, and presumably can be reweighted to reflect the total population,
I too think that the cigarette smoking questions should remain, tobacco has such an important impact on health and service utilisation.

I'm yet to see any research that shows that drug users are worred about the use of census data or any other large scale research data in relation to their freedom. Could you provide citations please Joanna for your assertions?

Hi Max. I made no claim that drug users in particular worry. I have heard many comments from people in general who suspect censuses, they worry about access to information and are concerned about their privacy. I believe that for them to see the census effectively (in their yes at least) asking people to 'dob themselves in' would just add fuel to their worries.

Ahh so its just anecdotal experience that you're basing a decision to collect extremely important data off? Good to know. My anecdotal experience including being a drug dealer and user for many years and interacting with thousands of others doing the same and then working in a social sector and interacting with users are that people are not as stupid as you say, and most drug users are intelligent enough to understand the concept of quantitative data.

Interesting to hear where your contra anecdotal evidence comes from though.

My name is Chris Bullen, a public health physician and researcher at The National Institute for Health Innovation, the University of Auckland. My primary research focus is on tobacco control and smoking cessation in particular. Our group of researchers met to consider the census questions and made the following comments about the tobacco questions.

The advantage the Census has to Health Survey data, which is mainly
- Representativeness
- Geographical information
but we acknowledge that you can only ask short and simple questions.
We strongly support including a smoking question for the following reasons:
- Need it for monitoring progress at the national, regional and more fine-grained (eg CAU level) information so targeted strategies can be implemented as needed to achieve the 2025 smoke free NZ goal
- The current question – do you smoke regularly one or more a day? YES/NO – should be extended to include an option about non-daily smoking, as this is likely to be a growing trend but we have little reliable data on this
e.g.
Do you smoke tobacco at all nowadays?
- Yes, every day.
- Yes, but only only on some days.
- No, but I used to.
- Never smoked

Hi everyone
A proposal has just been started, stating "Census smoking data can be used as a proxy for a general health indicator". You can find it, and vote, at the top right of this page.
Proposals are being used to try and sum up the discussion and get a quick snapshot on what people’s views on this issue currently are. Proposals are a way of not only checking where everyone is at with their thinking but drawing more people into the discussion. You can find a guide of how to use proposals here.
Proposals are not being used in the 2018 Census engagement discussion as a final decision making tool.
The proposal closes on Tuesday 2nd June at 12:00. However the discussion stays open until the 10th of June.

I would like to see how many smokers also have mental health issues, how will Census go about including that?

Why is there no proposal for including other drugs in the census? Or is this whole talkfest just about doing what has always been done? As thats exactly what this proposal suggests. Seems like a large waste of time. Can we please have a proposal on inclusion of other drug use in the Census.

Max I agree with many of the previous submitters. A question about illegal drug use is inappropriate in a census. Are you able to tell us more about how you plan to use the information gleaned from asking a question about illegal drug use in the census. How are you planning to use the data help reduce harm from drug use?

Hi Max. The cigarette smoking question is extremely important to health research as previous comments above have shown. While I can empathise your interest in the health consequences of the use of illegal drugs, census is not the correct place to enquire about illegal activities. Moreover, the use of illegal drugs is limited to a relatively small proportion of the population and the nature of the information (as someone above has pointed out) would likely be below the level of accuracy that would be useful. This would be a topic that is more effectively handled in a specifically targeted survey such as a health survey or a crime/victims of crime survey. It should also be noted that there is a very clear causal relationship between smoking and health conditions (such as some cancers). Having a consistent question on tobacco cigarette use allows people to monitor changes over time to measure the effectiveness of long-standing health initiatives. Adding additional questions to capture other drug use in the context of the census would be difficult because the information would only become usable if information about the type of drugs were included..

Why is it that blatant falsehoods seem to be so welcome here? "the use of illegal drugs is limited to a relatively small proportion of the population"
Fact: Almost half (46.4 percent) of New Zealanders aged 16 to 64 have used cannabis. One in seven (14.6 percent) adults aged 16 to 64 had used cannabis in the previous 12 months.

This is not much less than cigarettes which are decreasing:"the estimated smoking rate for people aged 15 years and over for 2008 is 21 percent.

So your statement on usage rates is incorrect.

statement Cannabis will be decriminalised and legalised eventually in NZ. It is important we begin to measure rates nationwide now.

"Having a consistent question on tobacco cigarette use allows people to monitor changes over time to measure the effectiveness of long-standing health initiatives." Having a consistent question on drug use allows people to monitor changes over time to measure the effectiveness of long-standing health and justice initiatives.

"would be difficult because the information would only become usable if information about the type of drugs were included" Thats the point, you don't say 'do you smoke?' in the census, it says 'do you smoke tobacco?' of course you would ask which drugs, as per my original statement.

Your whole comment is invalidated. Thanks!

So facilitator Tom, can we please have a proposal on usage of drugs.

Kia ora, I'm Bridget from the Ministry of Health and work on the New Zealand Health Survey. In response to the discussion above, here's some information...
SMOKING:
If you are interested in DHB statistics on current smoking and on daily smoking please see the http://www.health.govt.nz/publication/regional-results-2011-2014-new-zealand-health-survey. The regional statistics are provided for the Maori and for the total population.

More detailed statistics on tobacco use from the NZ Health Survey are reported here: http://www.health.govt.nz/publication/tobacco-use-2012-13-new-zealand-health-survey
RECREATIONAL DRUGS
You may also be interested in the recent NZ Health Survey publication on cannabis: http://www.health.govt.nz/publication/cannabis-use-2012-13-new-zealand-health-survey. Type of recreational drugs used in last 12 months is asked in the core survey - however it has not been published yet. (so latest publication is 2007/08 New Zealand Alcohol and Drug Use Survey).

MENTAL HEALTH
With regard to mental health and smoking the NZ Health Survey core survey includes self-reported doctor diagnosed mental health conditions, the K10 (a score of >=12 indicates psychological distress and high probability or an anxiety or depressive disorder) as well as the SF-12. Confidentialised Unit Record Files (CURFS) are available to researchers (subject to eligibility criteria) through Statistics New Zealand at http://www.stats.govt.nz/tools_and_services/microdata-access/confidentialised-unit-record-files.aspx.
We are currently scoping a Mental Health module for the 2016/17 NZ Health Survey.

Hi Bridget thanks for that. They are useful statistics. However for our work with local boards within councils the DHB statistics are far too broad a brush. The census smoking question is required.

Interesting, so its enough for cannabis but not enough for tobacco. Double standards.

I support the retention of questions about cigarette smoking. I'm not opposed to asking questions about the use of other substances.

I believe it's also important to know not just if a person is smoking, but did they also smoke at some point in the past (for example, one, two, five years ago)? Information on uptake and cessation rates may enable us to better forecast smoking prevalence in years to come, as well as gauge the effectiveness of initiatives designed to discourage smoking.

Dear all
My name is Bruce Bassett from Quitline.
I strongly support the retention of the smoking question. The government has established its Smokefree Aotearoa 2025 goal and it is important that the most robust data to track progress is in place.

Census is unique in that it provides disaggregated data on smoking in New Zealand, e.g. by fine geographic location, by ethnicity and can be related to levels of deprivation. Other data sources, such as the Health Survey, cannot provide this level of data.
We at Quitline rely heavily on this data to enable us to understand and target the most in-need smoker populations. For instance, we use geographic, ethnicity and deprivation data to focus our marketing strategies, from both creative and placement perspectives.

Quitline was active after the release of 2013 Census in requesting various cuts of the smoking-related data and this was widely used across the sector. Through this we understand that there is high level of demand for this data, with the bulk of this value being with the finely grained data.

Position: Retain the smoking question.

I agree, retain the smoking question

Agreed.

Agreed

Agreed that the illusion of consultation lives on and no change was ever going to be made and people asking for a proposal
on a very valid point will be ignored.

Hey guys, great to see people responding to the proposal. @brucebassett and @penelopescott thanks for showing letting us know what you think, but if you would like your views to be represented on the graph at the top right of the page then you should click the little thumb that best represents your view. It would be great if those who are voting could elaborate a little on why they are voting the way they are

Sorry but can’t see thumb!

@penelopescott It's right up the top of the screen, on the right hand side, just under the pie chart (which is all green at the moment). There are four buttons with hands on them.

Ah had forgotten to sign in!

I haven't got much time for an ongoing discussion and will put in a submission, so just want to stay brief:
1. 2018 is what the MOH and sector are calling a "benchmark" year for measuring ourselves against the Smokefree 2025 goal. So dissecting prevalence at the nth degree via the census will be vital in scoping our efforts moving forward, based on where the smoking populations still are.
2. it's not just about scoping our efforts forward, but measuring the impact of our efforts from one census to the next. A lot of change is going on in our sector, so where did we get it right? and where did we waste our limited resources?
3. my organisation also wants to compare children's exposure to secondhand smoke through analysing number of children residing in households where at least one resident smokes, region by region. This exposure is a significant risk to the goal, (indicator for future uptake) and provides scope for work in orgs serving family.
3. MOH do a rolling sample to analyse national prevalence, but digging down into meshblocks is really constructive both in terms of contract procurement, advocacy and health promotion.
4. I know you guys are used to alternating this question but please, until 2025, just keep it up every time. This shows cross-govt commitment to the goal and with this tracking aid, you can vouch for the question never being relevant again in just a couple more gos.
5. our most guaranteed tobacco control strategy is tax: we hope govt will keep raising tobacco's excise tax annually by at least 10% until 2025...if it does, we really need to analyse the correlation between smoking and deprivation and whether this is increasing over time.
6. my org is mainstream, but I can safely say all five reasons above are critical twice over for Maori and Pacific tobacco control organisations.
7. I'm not sure whether ASPIRE2025 have contributed here to loomio, but man you should see the output of analysis they provide based on census data. This evidence base is far more publicly referred to worldwide as well as by nz media, which lends itself to the public support for our 2025 goal. MOH punches out nothing but its singular survey report...not really helpful for health promotion.
I'm sure the discussion thread has iterated all 7 of these before, but I just wanted to make sure and lend my 10c worth

Thanks for freezing voices out of the conversation and offering no feedback 'Tom'. Is there any chance that any proposal will be made which isn't what the census was going to do anyway? I'm expecting this question to be ignored like my last few but hey you never know. Perhaps consultation isn't quite dead yet?

Hi
I work for a DHB. I support the 7 points Prudence has made above. This is no time to reduce data available to inform us of the progress towards minimising deliberate smoke inhalation re the 2025 goal and tobacco smoking. The latter, in the form of inhaling polluted air, is a large Public Health and Public cost matter. The cost to society of deliberate smoke inhalation lies in young people being restricted in their health by the time they are 30, if they started at the average age of 14 years, and an indicator of a burden promoting future ill health. We need all the tools available to inform us as to the consequences of measures put in place to reduce mass public smoke inhalation. In particular we need a national tool which can most clearly indicate which measures have been working to reduce smoking rates, in particular amongst Maori and Pacific Peoples, and in those that suffer from mental ill health. And yes we should have data on smoke inhalation from marijuana as an indicator of chronic ill-health, and that is an add on question not a replacement.

Some very good points have been made to support the inclusion of a question on smoking in the 2018 Census. Do we know how accurately people answer this question? And what is the non-response rate to this question. These are needed to be made clear in order to assess the value of the data.
I do NOT agree that a question on smoking is such an important indicator of health and health trends.

Ata marie, I am Kaiarahi (team lead) for a stop smoking service in the MidCentral Region. Firstly I support Prudence's 7 points.
Secondly, clients who are on the journey of stopping smoking are interested in the statistical information. It makes the census real and useful. Please keep the smoking questions in as they are highly valued.

Many thanks to Prudence. Excellent points, well expressed. To address Judith's concern though - non-response level is a very blunt measure of quality unless it is both very large and very biased in a way that is not measurable. But a bigger problem with data quality in general is how accurate the responses are. In the case of the smoking data there is a fair bit of published work which suggests that the quality is OK except for some groups where there are cultural pressures involved, but this in itself still makes the census data extremely useful because we then have a means of understanding the nature and extent of these effects, which we would not otherwise have. As Fay notes the census provides an excellent evidential base for following the changes in tobacco smoking behaviours.

We would like to remind everyone in this discussion that we have a terms of reference that you agree to when participating in this online engagement. This means engaging with each other respectfully and listening to other participants points of view. We welcome disagreement as long as the comments are constructive and not inflammatory.

Hi @maxdilloncoyle, apologies for not replying earlier. The current proposal is to gauge peoples views on the explicit topic of the thread. I'm open to putting up another proposal once the current one finishes provided that there are enough interested people. So what does everyone think, would a proposal on the inclusion of other substances be of value?

I am currently working in cessation and tobacco control in a PHO and second Prudence's post. The comments are most valid and to pick up on point 2, there is a significant drive for changes of approach to improve quit rates among various populations, lead by the MoH. This will inevitably lead to adaptations and innovations across the domain so the case for close term, geographically specific feedback will be as important in monitoring progress as ever.

I also support the inclusion of other substances in the census

Hi, I work in psychoactive industry and around policy consultation. Inhalation technology has changed now with trends toward electronic cigarettes, "SMOKING" is not the only form of nicotine delivery, I agree with others that data would be more useful if split between "SMOKING" and "VAPING."

I agree it would be good to collect socio/demographic/ethnic data on this trend so that if agreement is reached that e-cigarettes are a valid harm reduction strategy, messaging can be targeted.

It would be interesting to see more data on cannabis and other illegal drugs, but I agree that traceable self-reporting of activities which attract punitive measures is questionable data collection, census gives no safeguards or anonymity to consumers.

Given the significant numbers of consumers who tried other legal psychoactive substances (20% of adult population used BZP party pills) and the establishment of a regulatory agency for new psychoactive substances with demonstrably lower risk levels, and the international attention on the results of this new legislation, NZ has an international responsibility to collect data on the consumption patterns of newly developed psychoactive substances. However we have a couple of years to discuss this further before we are likely to see any new products.

It's as traceable and self reporting as the MoH study which health officials seem to be ok with relying on and drug users seem to feel happy filling out. Would be very good to have vaping included, I've noticed twice as many people at gatherings now vaping than smoking tobacco

Info needs to be collected on cannabis consumption as well as more people use cannabis than tobacco

Hi everyone,
Just a quick reminder that the consultation period is quickly coming to an end. There’s been some great discussion in this thread so far and I just wanted to encourage all of you to make a formal submission here before our engagement and consultation closes. All the discussions on loomio will be formally assessed but sending in a formal submission will add weight to whatever your position is. All formal submissions will be assessed against the Content Determination Framework.

I do not think cigarette smoking is a good overall indicator of health status. But that does raise the question about whether an overall indicator of health status would be valuable and to my mind YES it most certainly would be.
I suggested on the Loomio Disability theme that such a measure be included - though the discussion does not rightly belong there.
A single say 5-point rating scale of self-perceived health is proven reliable & very predictive. It could be useful for many purposes.
Can we have that please Tom, as a discussion proposal?

Hi @joannabroad,
The idea of having a self reported health indicator is interesting. I'm definitely open to putting up a proposal on that topic, but since it's outside of the explicit scope of this thread I'll have to mirror my earlier comment and say if enough other commenters express interest I'll put one up

Hi @tom_at_stats,
The idea came because of the proposal to use cigarette smoking as a health indicator, so that is why it is in here. I mooted this also on the Disability thread and the Housing thread.
At least one other has commented, but best if, as you say, it is made a separate thread.
Late in the consultation round now I admit, apologies!

That's no problem @joannabroad, it would be interesting to see if others, especially those in the health sector, would be interested in including some kind of self reported health question. It seems you feel very strongly about this issue so I would recommend making a formal submission here. It's the best chance to influence what is included in the 2018 Census.

Thanks @Tom (facilitator).
Let us see how wide the spread of interest is - though late in the Loomio day now.
Cheers.

Kia ora, my name is Bridget Forsyth & I work for the Cancer Society as the Health Promotion Co-ordinator for Southland. I agree with the many others that it is crucial to retain the smoking question to ensure monitoring at a more specific level than the NZHS can provide. I also agree with Chris Bullen that it would be good to have the question extended to capture non-daily tobacco use. This may well be a growing trend. As will e-cigarette use & it would be good to have a gauge on the numbers there, especially given the lack of consensus on their safety. While it would be useful to have some solid figures around drug use, I suspect that needs to be raised in a whole new thread to be discussed fully. I agree that the illegal nature would possibly make people wary. I don’t think it’s a case of people being stupid & not understanding that it would be confidential, rather that there is a certain amount of distrust of government especially after criticisms of the GCSB. While I don’t have any empirical evidence to support this concern, I know that I was distrustful of the claims of confidentiality when I was younger before I studied epidemiology & public health. I don’t think I was particularly exceptional in this distrust but perhaps this needs to be investigated further. I haven't found any research to this effect involving the NZ Census so far.
Kā mihi

Excellent

Hi Tom

I made a submission supporting Prudence's points made and adding other comments. It seems something else happened that made myself and a lot of others' comments invalid in the final analysis.

When did the poll you set arise? and why was there no contact to let us know to complete the poll question? I feel cheated about this.

Karen Stevens
Auckland
New Zealand
Mobile 0273267334
Email: kstevens24C@gmail.com ( kstevens24C@gmail.com )

Hi @karenstevens1, the proposal poll was active at the time you made your comment. The proposal had buttons that people used to show whether they agreed or not, not from the comments section itself (though voters choices did appear in the thread).

Everyone in the health group should have received an email when the proposal was created. If you didn't receive an email you may have joined the group after the proposal went live.

The proposals are meant more to encourage discussion than to measure consensus. Rest assured that your comments will be taken into account in the final analysis as will everyone's.

Kia ora Tom, I never saw Karen's proposal poll, perhaps because I signed up after, but all the same I can see no signs of it even though I can see at least two of the previous ones (Information on smoking is still reuired at low levels of geography & Census smoking data can be used as a proxy for a general health indicator). Is it possible there was a glitch?

Hi @bridgetforsyth, I think some wires have been crossed. Only facilitators, such as myself, can create proposals. Maybe I misinterpreted @karenstevens1 comment. I thought Karen's comment was about why her previous comment hadn't been incorporated into the "Smoking information is still required at low levels of geography" proposal. Though I might have been wrong