New Zealand's accelerating smoking decline: lessons for tobacco harm reduction.

Following implementation of key measures of the WHO Framework Convention on Tobacco Control (FCTC), adult smoking rates in New Zealand declined slowly. However, from 2018/19, smoking prevalence declined rapidly, coinciding with increased uptake of vaping following regulatory clarification and their endorsement as a cessation aid. Joinpoint regression analysis confirms this period as a statistically significant acceleration in decline compared with earlier trends. The reduction has been most pronounced among Māori and younger adults, consistent with higher uptake of vaping in these populations. Adult daily smoking has now plateaued at below 7%, reflecting an increasing concentration of smoking among Māori, older, and more socioeconomically disadvantaged groups. By contrast, youth smoking remains at historically low levels, and youth vaping has declined following regulatory tightening. New Zealand's experience suggests that harm reduction, implemented alongside FCTC measures and proportionate regulation, can accelerate declines in smoking while maintaining low youth smoking rates.