What will the Government’s free vape starter kit programme achieve?

On New Year’s Eve, Associate Health Minister Casey Costello announced that 24 Te Whatu Ora funded stop smoking services throughout Aotearoa would provide free vape starter kits to adults who smoke. Several media reports (see here and here) have questioned the procurement process and raised important questions about the tobacco and vape industry's influence over Government decisions. In addition to investigating these questions, it is important to examine what impact the Government’s new approach is likely to have. 

How many people need to stop smoking for Aotearoa to achieve the Smokefree 2025 goal? 

The Smokefree goal, recommended by the Māori Affairs Select Committee in 2010, and adopted by the Government in 2011,  means daily smoking prevalence of less than 5% in all population groups. Minister Costello has endorsed this goal, saying “[W]e are committed to achieving the less than 5% smoke-free targets across all populations”.

The 2023/24 New Zealand Health Survey (NZHS) reported that 298, 933 people smoke daily. Conservatively, using NZHS data and assuming the overall population size remained the same, a smoking prevalence of under 5% in 2025 would mean fewer than 216,618 people smoked daily. Achieving the Smokefree 2025 goal would thus require at least 82,315 people to stop smoking in 2024/25. 

However, the goal’s focus on equitable reductions in smoking prevalence means its achievement actually requires higher cessation rates. For each population group to reach the target, more than 62,500 Māori, 21,000 Pacific Peoples and 34,700 European/other would need to stop smoking (Table 1). The goal has already been realised among Asian peoples. ^Note 

Over the previous seven years, the number of people who smoke daily has fallen on average by 11,500 for Māori, 2,200 for Pacific Peoples and 25,000 for European/Other each year, averaging 34,000 people per year overall. ^Note To reach the goal will require a very large increase in quitting, over and above these background rates of smoking decline. Will the Government’s new vape kit initiative make a difference? 

Table 1: Numbers in each population group needed to stop smoking to achieve the Smokefree 2025 goal, based on New Zealand Health Survey data

^# Using total response ethnicity classification 
* Using NZHS estimates for 2023/24
^§ Smokefree 2025 goal is defined as <5% daily smoking prevalence in each population group

How many people will the vape starter kit provision programme help to stop smoking?

Data from Te Whatu Ora indicates it purchased 3,430 vaping devices and sufficient e-liquid pods to offer people three months’ supply. Although vapes have been shown to help people stop smoking,¹ realistically, only a fraction of the people provided with a vape will become smokefree at the end of three months and some will relapse beyond that point.

Compared to traditional nicotine replacement therapies, people who use nicotine vapes as a quitting aid are more likely to be smokefree at 3-6 months. A recent systematic review found “for every 100 people using nicotine e‐cigarettes to stop smoking, 8 to 10 might successfully stop, compared with only 6 of 100 people using nicotine‐replacement therapy, 7 of 100 using e‐cigarettes without nicotine, or 4 of 100 people having no support or behavioural support only.”¹ 

Recent trials suggest improvements in vaping technology have increased quit rates when compared with earlier trials.² Furthermore, the initiative includes behavioural support from stop smoking providers alongside free vape kits, which may improve quit rates compared with provision of vapes alone. On the other hand, calculations also need to account for relapse to smoking after three months. A recent study investigated relapse rates by vaping status and found quitters who had never vaped and those who continued to vape regularly both had the same relapse rate of around 32%.³ Because parameters are uncertain, we have used both optimistic and pessimistic assumptions in our calculations to estimate what proportion of the 3,430 people provided with free vape kits will remain smokefree at three months and beyond. (Table 2; see Appendix for further details). 

Table 2: Estimated number of people stopping smoking long term that may arise from the NZ Government provision of vaping kits in 2025

These calculations suggest that, if all free vape kits supplied to stop smoking providers are distributed, 3,430 people will make quit attempts using the kits; at best, 466 of these may successfully stop smoking and remain smokefree long term. Around 40% of people might have stopped smoking anyway¹, using previously available supports (or no support), so assuming these people are additional quitters is a generous assumption. 

In conclusion, providing free vape kits will have little impact on achieving the Smokefree 2025 goal, helping fewer than 1% of the more than 82,000 people needed to quit smoking. Sadly, no policy will now see the 2025 Smokefree goal realised by the end of this year; however, the Government should be doing its best to reduce smoking prevalence rapidly and equitably using evidence-based methods. At this point, denicotination of smoked tobacco is the only policy predicted to catalyse rapid reductions in smoking prevalence across all population groups within a short timeframe.

Author details

Calvin Cochran, Research Fellow, ASPIRE Aotearoa Research Centre, Department of Public Health, University of Otago Wellington. 

Dr Jude Ball, ASPIRE Aotearoa Research Centre, and Senior Research Fellow, Department of Public Health, University of Otago Wellington 

Prof Janet Hoek, Co-Director of ASPIRE Aotearoa Research Centre, and Department of Public Health, University of Otago Wellington

Disclosure: Calvin Cochran also works part-time as the policy lead for Vape-Free Kids NZ.

NOTE: The New Zealand Health Survey (NZHS) uses ‘total response’ ethnicity classification, meaning individuals are counted in every ethnic group they identify with. As a result, the sum of ethnic-specific figures (such as smoking rates or required quits) may exceed the overall total, and it is difficult to determine exactly how many unique individuals would need to quit smoking to meet the 2025 goal. However, this number is likely to be greater than the 82,315 estimate above.

Appendix

Calculations and assumptions for estimated number of people stopping smoking long term that may arise from the NZ Government provision of vaping kits in 2025   

Our calculations are based on 3,430 people being provided with free vape kits.

The Cochrane Review¹ states "For every 100 people using nicotine e-cigarettes to stop smoking, 8 to 10 might successfully stop, compared with only 6 of 100 people using nicotine-replacement therapy, 7 of 100 using e-cigarettes without nicotine, or 4 of 100 people having no support or behavioural support only."

Based on this evidence, we assumed 10% of people using nicotine e-cigarettes to stop smoking would stop smoking successfully in our pessimistic scenario. We doubled the assumed quit rate for our optimistic scenario, to consider the fact that people would receive modern vaping devices and be offered behavioural support. 

Dai & Leventhal ³ found that among recent quitters (N = 884), the prevalence of follow-up smoking relapse was 31.6%, 39.0%, 51.6%, and 31.9% among never (N = 233), prior (N = 399), current occasional (N = 56), and current regular (N = 196) baseline e-cigarette users, respectively. We have used a conservative relapse rate (32%) for all scenarios, based on the ‘current regular e-cigarette users’ rate. 

Table A1. Scenario assumptions

Te Whatu Ora data on stop smoking rates 

Data from a Te Whatu Ora Official Information Act request estimates there were approximately 14,552 enrolments in face-to-face stop smoking services per year (July 2016 – December 2022). The data estimates a 12% long-term (one-year) quit rate which represents 1,746 people quitting each year. Given that about 34,000 people stop smoking each year, these figures suggest only a very small minority (about 5%) do so with the help of Te Whatu Ora stop smoking services. The Te Whatu Ora one-year quit rates are likely an overestimate with long term quit rates found to be much lower in the Cochrane Review mentioned above. 

Investment needed to reach the Smokefree Goal via supply of vape-kits 

A lower-cost solution to rapidly reducing smoking rates remains denicotinisation of tobacco products as the costs are ultimately borne by the tobacco companies wishing to compete in the New Zealand market, rather than the Government.

Table A2: Costs of scaling up vaping kit programme