Spatial scale and the geography of tobacco smoking in New Zealand: a multi-level perspective

Smoking in New Zealand is more common in deprived areas and in areas with a significant Maori population. Despite its status as a major health problem there has been little work investigating this apparent geography of smoking. Data from the 1996 Census is used to construct a multilevel proportions-as-responses model of smoking prevalence. This enables an exploration of the geography of smoking at different spatial scales. Levels within the model distinguish contextual variation between local authorities, census area units and meshblocks. Particular account is taken of the influence of deprivation and ethnicity on smoking. Results confirm the importance of ethnicity and deprivation and indicate that cross-level interaction between meshblock and census area units measures is significant. They also challenge crude stereotypes about the apparent geography of smoking and suggest that, while levels of smoking may be high in parts of North Island, they are less high than might be expected given the socio-demographic composition of the areas concerned. Conversely, smoking is more prevalent than expected in parts of South Island. The paper notes the health policy implications of these emergent geographies.