Janet Hoek

University of Otago · Department of Public Health (Wellington)

Background Concerns about the effects of vaping have prompted calls to restrict e-cigarette flavours. Vaping proponents have criticised these proposals, which they argue may discourage smokers from taking up vaping or trigger relapse to smoking. We explored the role flavours play in vaping uptake and cessation among New Zealand cigarette smokers an...

Abstract Background Although loss-framed pictorial warning labels (PWLs) have increased knowledge of the health harms caused by smoking, they may elicit maladaptive responses among some smokers who have tried repeatedly, yet unsuccessfully, to quit smoking. However, research suggests that maladaptive responses may diminish if warnings are complemen...

Abstract Background While cigarette filter modifications have long been used to increase product appeal and assuage health concerns, tighter marketing restrictions, including plain packaging, have further spurred the growth of filter variants. We explored and assessed experiences and perceptions of smokers who had tried and/or currently use recesse...

New Zealand’s early response to the novel coronavirus pandemic included a strict lockdown which eliminated community transmission of COVID-19. However, this success was not without cost, both economic and social. In our study, we examined the psychological wellbeing of New Zealanders during the COVID-19 lockdown when restrictions reduced social con...

Background Little is currently known about how e-liquid flavour use evolves among electronic cigarette users. We describe patterns of e-liquid and flavour category use, and variety-seeking, among New Zealand adult smokers attempting to transition from smoking to e-cigarettes. Methods Data were collected in 2018–19, using a longitudinal design comp...

Introduction Rising use of electronic nicotine delivery system (ENDS) among young people, especially those who have never smoked, has received considerable attention from the health community. However, fewer studies have examined the mental health impacts of ENDS use. We addressed this gap by exploring the stigma, altered self-perceptions and negat...

Introduction In line with historical tobacco industry marketing claims, many consumers perceive cigarettes with filters as less harmful than cigarette without filters. However, scientific evidence indicates that cigarette filters do not reduce the risks associated with smoking. We examined opposition to banning the sale of cigarettes with filters,...

Background: Pictorial health warnings on tobacco packs can stimulate short-term cognitive and emotional responses that lead to quit attempts. We tested novel product attribute health warnings (PAHWs) that corrected misperceptions about harm created by the use of filter-venting, menthol and roll-your-own tobacco. PAHWs uniquely influenced outcomes a...

Background/aims Regulatory schemes for tobacco retailing help restrict the supply and availability of smoked tobacco products. Tobacco retailer density and the proximity of tobacco outlets to youth spaces, such as schools, are greater in more disadvantaged areas. Exposure to tobacco retailing normalises smoking and increases ease of access, thus in...

Introduction Young people who use nicotine‐containing electronic cigarettes, or ‘vapes’, risk becoming addicted to these products. While several studies document dependency symptoms, few report in‐depth qualitative analyses of addiction. Methods We explored experiences of self‐reported vaping addiction using in‐depth interviews with 22 young peopl...

aim: Regulations announced in mid-2023 aimed to reduce youth vaping by curtailing the availability of cheap high-nicotine e-cigarettes (vapes). This study tested compliance with the new regulations for single-use vapes, which came into force on 21 December 2023. methods: A 20-year-old “mystery shopper” visited 96% of specialist vape retailers (SVRs...

Introduction Although pictorial warning labels (PWLs) now dominate tobacco packages sold in many countries, few studies have probed how people who smoke respond to the threats presented several years post-plain packaging and larger PWLs. Understanding how people manage the fear and dissonance PWLs arouse, and the strategies they use to rationalize,...

Introduction Despite policies setting a minimum legal sales age, youth continue to access electronic cigarettes (ECs). Evidence of rising youth vaping prevalence in many countries suggests existing measures have serious loopholes and raise important questions about how youth source vaping products. Methods We explored how youth source ECs using in...

Objective We synthesised the published literature on proposals to restrict tobacco supply to pharmacies, covering (1) policy concept/rationale/attempts, (2) policy impact and implementation and (3) policy and research recommendations. Data sources We searched eight databases (PubMed, CINAHL, Scopus, Web of Science, Embase, IPA, ProQuest and OATD)...

Background Aotearoa New Zealand proposed a new maximum nicotine content of 0.8 mg/g for smoked tobacco products, although the new government plans to repeal this legislation. Requiring ‘Very low nicotine’ (VLN) messages on cigarettes meeting this standard may reinforce misperceptions that they are less harmful than cigarettes currently sold. Metho...

Background Aotearoa New Zealand passed world-leading legislation to implement tobacco endgame policies, including greatly reducing the number of tobacco retailers. British American Tobacco New Zealand and Imperial Brands Australasia tried to undermine this policy via the ‘Save Our Stores’ (SOS) campaign, which purportedly represented small convenie...

Background and aim Social practices such as smoking–drinking co‐use often go ‘hand‐in‐hand’, linked by the coordination of materials, skills and meanings. However, the experience of using e‐cigarettes while drinking among people who smoke (and drink) remains underexplored. We used social practice theory to show how smoking, vaping and drinking inte...

Introduction Tobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, others have suggested limiting tobacco sales to pharmacies, to reduce supply and support cessation...

Background Despite measures to reduce young people’s access to electronic cigarettes (ECs), or “vapes”, many countries have recorded rising youth vaping prevalence. We summarised studies documenting how underage youth in countries with minimum age sales restrictions (or where sales are banned) report accessing ECs, and outline research and policy i...

Objective: This article aims to examine the impact on adolescents of New Zealand's 2018 legislation introducing plain (standardised) packaging and enhanced pictorial warning labels (PWLs). Methods: Data came from Year 10 (14-15 years old) students in the 2016 (2,884 participants) and 2018 (2,689 participants) Youth Insights Surveys conducted 2 y...

Introduction Menthol facilitates smoking initiation among young people, enhances nicotine’s addictiveness and fosters the false belief that menthol products are safer. As a result, several countries have banned use of menthol as a characterising flavour. Aotearoa New Zealand (NZ) could disallow menthol-flavoured cigarettes as part of its endgame le...

Introduction: Tobacco companies claim that substantially reducing tobacco retail outlets in Aotearoa New Zealand will increase illicit tobacco trade and crime. However, we know little about whether people who smoke anticipate using illicit tobacco once this measure is implemented. Exploring current illicit tobacco use and expected market developme...

Background Aotearoa New Zealand plans to greatly reduce tobacco retail outlets, which are concentrated in areas of higher deprivation and perpetuate health inequities caused by smoking and borne particularly by Māori. However, we lack in-depth analyses of how this measure could affect people who smoke. Methods We undertook in-depth interviews with...

Health warning labels (HWLs) on alcohol containers may help reduce population-level alcohol consumption. However, few studies have examined the most effective formats for alcohol HWLs. This study tested the effects of three different types of alcohol HWLs. In an online experiment, N = 1,755 Australian adult drinkers were randomly assigned to one of...

Introduction For electronic nicotine delivery systems (ENDS) to reduce harms caused by smoking, people who smoke must be able to switch to exclusive ENDS use without subsequently returning to smoking. Identifying factors prompting a return to smoking among former exclusive ENDS users is crucial, yet few qualitative studies have probed experiences o...

Introduction: Aotearoa New Zealand (NZ) plans to introduce a smoke-free generation (SFG) policy, alongside denicotinisation and reducing the availability of tobacco products. The SFG has a clear rationale, yet we know little about how young people, those the policy targets, perceive it. To inform policy design, communication and implementation, we...

Introduction Advocates of electronic nicotine delivery systems (ENDS) increasingly use Twitter to promote liberal ENDS policies. ‘World Vape Day’ (WVD) is an annual campaign organised by pro-ENDS advocacy groups, some of which have links to the nicotine industry (e.g., via funding from ‘Foundation for a Smoke-Free World’). In 2020, the campaign use...

Introduction: Social interactions help smoking and vaping practices evolve, and are essential when constructing social identities. Among people who smoke, vaping offers an alternative practice to 'smoking' and 'non-smoking', and using e-cigarettes blurs the boundaries between 'smoker' and 'non-smoker' social identities. In this study, we explored...

BACKGROUND Aotearoa New Zealand (NZ) is a country with a tobacco endgame plan that includes denicotinisation of tobacco. Because of concerns these measures could increase tobacco smuggling, we aimed to provide new baseline data on such smuggling. We studied littered tobacco packs during a ‘natural experiment’ when no international tourists and re...

Background Between 2010 and 2020, the New Zealand (NZ) Government increased tobacco excise tax by inflation plus 10% each year. We reviewed market structure changes and examined whether NZ tobacco companies shifted excise tax increases to maintain the affordability of lower priced cigarette brands. Methods We cluster-analysed market data that toba...

Introduction Electronic nicotine delivery systems (ENDS) likely pose fewer health risks than smoking. Yet ENDS uptake has increased among never-smoking young adults, who likely face greater health risks relative to non-users of ENDS. To date, few qualitative studies have explored ENDS uptake and use by never-smokers. Methods We conducted in-depth,...

As debate persists over regulating electronic nicotine delivery systems (ENDS), those favouring liberal ENDS policies have advanced rights-based arguments privileging harm reduction to people who smoke over harm prevention to children and never-smokers. Recent ethical arguments advocate regulating ENDS to prioritise their harm reduction potential f...

Objective The COVID-19 pandemic and associated restrictions are associated with adverse psychological impacts but an assessment of positive wellbeing is required to understand the overall impacts of the pandemic. Methods The NZ Lockdown Psychological Distress Survey is an on-line cross-sectional survey of 3487 New Zealanders undertaken during a st...

Identifies how small convenience stores are sub-dividing their premises to create specialist vape stores.

Objective Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities. Data sources Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) fo...

The aim of this paper is to overview progress made with respect to the adoption of plain (or standardised) packaging, key challenges faced, evaluative evidence and opportunities for extending this policy. It has been a decade since Australia became the first country to require tobacco products to be sold in plain packaging; after slow initial uptak...

Some tobacco companies claim they are ‘transforming’ by adopting harm reduction goals or even seeking to achieve a ‘smokefree’ world. What characterises transformation and whether companies can or are transforming is unclear. Nevertheless, such claims are gaining traction. We critically investigated tobacco industry transformation by exploring the...

Aim: To provide preliminary high-level modelling estimates of the impact of denicotinisation of tobacco on changes in smoking prevalence in Aotearoa New Zealand relative to the New Zealand Government's Smokefree 2025 goal. Methods: An Excel spreadsheet was populated with smoking and vaping prevalence data from the New Zealand Health Survey and w...

Background People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. Aim This study explored smoking in acute metal hea...

Background Although the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking. Methods We identified biomarkers with specificity of association with diffe...

For several decades, the Journal of Public Policy & Marketing has stimulated and led debates with far-reaching implications for consumer well-being, global relationships and, ultimately, human survival. The challenges we face have not disappeared but intensified. Today, we must respond to climate change, manage a global pandemic, and address dispar...

Introduction: New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we add...

Aim: To provide preliminary high-level modelling estimates of the impact of denicotinisation of tobacco on changes in smoking prevalence in Aotearoa New Zealand (NZ). Methods: An Excel spreadsheet was populated with smoking/vaping prevalence data from the NZ Health Survey and business-as-usual trends projected. Using various parameters from the lit...

Social media promotions of vaping products post legislation restricting advertising and sponsorship by these products.

Discussion of proposed policy to limit alcohol advertising and sponsorship.

Objectives: We aimed to examine patterns in smoking and electronic nicotine delivery system (ENDS) use over an extended period of time (up to 20 weeks) in people who smoked and who had never previously made a successful quit attempt using an ENDS. Design and setting: We conducted a longitudinal mixed-methods study in Dunedin, New Zealand, during...

Many current smokers incorrectly believe that menthol cigarettes are less harmful, likely due to the biological and sensory effects of menthol, which can lead smokers to have favourable sensory experiences. In this study, we measured the extent to which Australian smokers associate certain sensory experiences with smoking menthol and non-menthol ci...

The COVID-19 pandemic has caused significant disruption, distress, and loss of life around the world. While negative health, economic, and social consequences are being extensively studied, there has been less research on the resilience and post-traumatic growth that people show in the face of adversity. We investigated New Zealanders’ experiences...

Introduction Although roll‐your‐own (RYO) loose tobacco is increasingly popular among smokers, no jurisdictions have used RYO‐specific pictorial warning labels (PWL) on tobacco packaging. We explored how New Zealand RYO smokers, a population with over 10 years of exposure to PWLs, reacted to RYO‐specific warnings featuring novel themes. Methods We...

The public will soon have the opportunity to make submissions on the long-awaited Smokefree Environments and Regulated Products (Vaping) Amendment Bill ('the Bill') which will regulate vaping products and alternative nicotine delivery systems. In a previous blog, ASPIRE 2025 researchers summarised the strengths and limitations of the Bill, and conc...

Introduction New Zealand’s response to the COVID-19 pandemic was one of the most restrictive lockdowns of any country, inevitably causing stress for many people. Because situations that increase stress and anxiety are associated with higher smoking prevalence, we examined self-reported smoking before and during the lockdown, and analyzed factors as...

Background Policymakers wishing to encourage smokers unable to quit to switch to using electronic nicotine delivery systems (ENDS) also need to consider how to deter ENDS use among non-smokers. We examined whether reduced-risk messages could increase ENDS’ appeal among smokers and if increased-risk messages could decrease appeal among susceptible n...

Introduction Although the harm to health from electronic nicotine delivery systems (ENDS) use relative to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking. Methods We identified biomarkers with specificity of association with...

Drawing on a retrospective case study involving LGBTQ populations and the tobacco industry, we demonstrate how a duplicitous stance by Big Tobacco illuminates the ways that symbolic violence is perpetrated on consumers. We define marketplace violence as the actions and narratives of powerful market actors that perpetuate inequalities that less powe...

Abstract Introduction New Zealand’s Smokefree 2025 goal aims to greatly decrease the availability of tobacco. One option is to cease the sale of tobacco from convenience stores. However, tobacco companies and retail trade associations oppose this move and have argued that customers who purchase tobacco drive footfall and spend more than non-tobacco...

Background Smoking among young adults is often associated with social contexts and alcohol use. While many countries, including New Zealand, have prohibited smoking inside licensed premises, outdoor areas have enabled smoking and alcohol co-use to persist. We examined whether and how outdoor bar areas facilitate and normalise young adult smoking, a...

Abstract Aims Across three eye‐tracking studies, we examined how cigarette pack features affected visual attention and self‐reported avoidance of and reactance to warnings. Design Study 1: smoking status × warning immediacy (short‐term vs. long‐term health consequences) × warning location (top vs. bottom of pack). Study 2: smoking status × warning...

Aims Across three eye‐tracking studies, we examined how cigarette pack features affected visual attention and self‐reported avoidance of and reactance to warnings. Design Study 1: smoking status × warning immediacy (short‐term vs. long‐term health consequences) × warning location (top vs. bottom of pack). Study 2: smoking status × warning framing...

As more countries set smoking endgame goals and introduce measures to denormalize smoking, smokers’ experience of stigma may intensify and require new management strategies. Probing the tension between environmental changes that support population-level behaviour change and individuals’ sense making, which occurs at a micro, everyday level, provide...

Abstract Introduction If electronic nicotine delivery systems (ENDS) are to bring public health benefits, members of population groups most affected by smoking must find them an easily adopted and satisfying replacement for smoking. We explored experiences of ENDS uptake and use among Māori and Pacific peoples living in New Zealand, and probed fact...

Minister Jenny Salesa announced the Government's long-awaited Smokefree Environments and Regulated Products (Vaping) Amendment Bill on Sunday 23 February. The Bill contains some important provisions as it works to strike a balance between ensuring regulated products are available to smokers wishing to quit, while at the same time minimising uptake...

Introduction Many smokers who begin using electronic nicotine delivery systems (ENDS) report vaping in settings where they would not have smoked and believe secondhand aerosol (SHA) is simply steam. However, current understanding of how ENDS users differentiate between secondhand smoke and SHA, or how vaping norms develop, is limited. Methods We c...

Background Many countries have seen roll-your-own (RYO) loose tobacco use increase, despite policies to reduce smoking prevalence. On-pack pictorial warning labels (PWLs) typically feature general warnings about smoking, and no jurisdictions link these to specific types of tobacco (ie, RYO tobacco or tailor made cigarettes). We explored the warning...

Debate over tobacco tax increases has intensified as research indicates potentially conflicting policy directions. On the one hand, excise tax increases continue to stimulate quit attempts among smokers yet, on the other hand, they may lead to financial hardship for some smokers and increase retail crime. In this blog, we explore how allocating a p...

There is a growing literature on regulating the supply of tobacco products to achieve tobacco-free goals. This article suggests three goals and eight principles that could underpin regulatory approaches to the supply of tobacco and non-prescription nicotine products. The primary principles are that tobacco and nicotine products should not be seen a...

Abstract Introduction In 2017, the New Zealand (NZ) Government announced its intention to liberalise the sale and promotion of electronic nicotine delivery systems (ENDS), including permitting any outlet to sell ENDS. This research estimated the proportion of tobacco outlets selling ENDS prior to legislative change, documented ENDS point-of-sale ma...

Summary New Zealand urgently needs effective regulation that prevents the seductive marketing of vape products to young people. Few of New Zealand vape marketing websites, or their easily accessible Face-book or Twitter accounts, had health or addiction warnings. Two of the most popular websites had over 170 fruit/candy flavoured vape refills. Ab...

AIMS: To examine the characteristics of the online marketing environment and the presence of safeguards to protect children from e-cigarette (ENDS) experimentation and uptake in New Zealand. METHODS: The search engine ‘Google Chrome’ was used to identify New Zealand vendor websites, Facebook and Twitter accounts. ‘YouTube NZ’ was searched for video...

Introduction In 2017, the New Zealand Government signalled its intent to legalise the widespread sale of Electronic Nicotine Delivery Systems (ENDS), which many New Zealand retailers have actually sold for several years. Although ENDS uptake may reduce the harm smokers face, it requires them to adopt an entirely new practice; we therefore explored...

Nuyts et al.’s call for the tobacco age-of-sale to rise to 21 raises important and timely questions.¹ Specifically, it highlights the importance of reducing access to tobacco, which, in many countries, remains as widely available as staple household products such as bread and milk.² Debate over tobacco’s accessibility has occurred over several deca...

Aims: Across three eye-tracking studies, we examined how the location, framing, immediacy, and severity of health warnings on branded cigarette packs affected visual attention and self-reported avoidance of and reactance to warnings. Design: Study 1: smoking status × warning immediacy (short-term vs. long-term) × warning location (top of back vs. b...