Tobacco smoking is common among people with mental illnesses, and they carry a higher burden of smoking-related illnesses. Despite this, smoke-free policies and systems for supporting cessation have proved difficult to introduce in mental health and drug and alcohol services (MHDAS). This paper examines the barriers to becoming smoke free within New Zealand services. Key informants, including staff, smoke-free coordinators, and cessation specialists were interviewed. Of the 142 invited informants 61 agreed (42%) to participate in a telephone interview, and 56 provided useable data. Organizations had a permissive or transitioning smoking culture, or were smoke free, defined by smoke-free environments, smoke-free-promoting attitudes and behaviours of management and staff, and cessation support. Most organizations were on a continuum between permissive and transitional cultures. Only eight services had a fully smoke-free culture. MHDAS face many challenges in the transition to a smoke-free culture. They are not helped by exemptions in smoke-free policies for mental health services, staff smoking, negative staff attitudes to becoming smoke free, poor knowledge of nicotine dependence, smoking-related harm and comorbidities, and poor knowledge and skills regarding cessation-support options. Health inequalities will continue across both service and socioeconomic divides without a concerted effort to address smoking.

Smokers unmotivated to quit reduce their usual cigarette consumption (and thus nicotine exposure) when VLNC cigarettes are made available at a significantly reduced price.

Using electronic cigarettes (vaping) is controversial, but is increasingly widespread. This paper reports the results of an electronic survey of vapers in New Zealand, a country where the sale and supply of e-liquids containing nicotine is illegal, although vapers can legally access e-liquids from overseas. An on-line survey was conducted, using vaper and smoking cessation networks for recruitment, with follow up surveys conducted 1 and 2 months after the initial survey. 218 participants were recruited. Almost all had been smokers, but three quarters no longer smoked, with the remainder having significantly reduced their tobacco use. Three participants were non-smokers before starting to vape, but none had gone on to become smokers. The overriding motivation to begin and continue vaping was to stop or to reduce smoking. The results were consistent with a progression from initially both vaping and smoking using less effective electronic cigarette types, then moving to more powerful devices, experimentation with flavors and nicotine strengths—all resulting in reducing or stopping tobacco use. Lack of access to nicotine and lack of support for their chosen cessation method were the main problems reported. Vaping had resulted in effective smoking cessation for the majority of participants.

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Many provinces, municipalities and cities are working towards meeting the 2011 deadline imposed by the Ministry of Health and other health authorities for all health care facilities and organisations to be smoke free. Government and non-government funding is supporting this initiative.