Tobacco + Addiction

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Tobacco, excessive alcohol use, problematic illicit drug use and problem gambling are ‘dangerous consumptions’ that have a significant negative emotional and financial impact on individuals, their families/whanau and the community. Many individuals engage in more than one type of dangerous consumption. The Addiction Research theme investigates innovative, but practical, solutions to reducing these health risks, particularly focusing on priority population groups. Studies test the effectiveness of novel delivery systems, variations in the delivery of standard treatments, or novel treatments, and often utilise the pragmatic community-based trial design to ensure generalisability of the findings to the ‘real world’. 

Current research highlights

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The harms from gambling can be mild to severe but they are often hidden. People who experience harms and problems from gambling do not readily seek help from the available treatment services, when they may need it. This may be due to feelings of stigma or a sense of shame (whakamā, lagona o le maasiasi), difficulty accessing services (location, timing), and whether they feel culturally appropriate. For these reasons, our research into gambling is focused on developing and testing mobile phone-based applications (apps) that can be used by anyone at anytime and anywhere, to help provide evidence-based support.

Manaaki is a cognitive behavioural therapy app for people experiencing gambling harms or problems. It has been developed at the National Institute for Health Innovation and is based on the Deakin University GAMBLINGLESS on-line tool. While Manaaki is evidence-based, the method of delivery—via an app—is new. The study is supported by a research grant from the Health Research Council, in partnership with colleagues from Social and Community Health of the University of Auckland, Deakin University, and Hāpai te Hauora.

The Manaaki study aims to evaluate the effectiveness of Manaaki for people experiencing gambling harms or problems, using a randomised study design. Manaaki aims to recruit adults (18 or older) living anywhere in New Zealand, who feel they may be experiencing gambling harms or problems.

Participant recruitment for Manaaki has finished. The results of the study will be shared once they are available.

Click here for more information about Manaaki.

mCessation Cook Islands

Building on the STOMP mCessation programme and recent work in Samoa (TXTTaofiTapaa) this WHO funded project involves the adaptation and piloting of the mCessation programme for the Cook Islands. Working with the local Cook Islands Ministry of Health and key stakeholders the existing programme will be adapted, translated and then piloted and evaluated in the Cook Islands providing a simple and accessible smoking cessation intervention.

For more information please contact Associate Professor Robyn Whittaker or Dr Rosie Dobson.



RAUORA was an HRC-funded, single-blind, randomised, non-inferiority randomised controlled trial examining the effectiveness and safety of cytisine (Tabex®) compared to varenicline (Champix®) for smoking cessation in Māori and whānau of Māori. The trial was led by Associate Professor Natalie Walker  in collaboration with the School of Pharmacy, University of Auckland, Brunel University London, and the Lakes District Health Board. The trial to enrolled 679 participants who were daily smokers (≥18 years), and lived in the Bay of Plenty, Tokoroa and Lakes District Health Board region of NZ.  Results indicated that cytisine was at least as effective as varenicline at supporting people to quit, with significantly fewer adverse events. The trial protocol and results were published in the journal ‘Addiction’. 

For more information see the study website here.


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In China, around 60% of men aged 25-44 years smoke tobacco. This group (about 250 million people in number) is the target of a study led by PhD student Jinsong Chen. His supervisor, Professor Chris Bullen says “Jinsong has developed and tested a unique smartphone smoking cessation app within WeChat, China’s most popular social media platform. Remarkably, all development work with app end users and a pilot randomised trial to evaluate effectiveness on smoking status has been conducted digitally –remotely –with no face to face contact.” The results of the trial are due later this year.

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A randomised-controlled clinical trial designed to evaluate the effectiveness and safety of an adaptive treatment for smoking cessation in people with mental health problems and addictions.

The project is funded by the Health Research Council of New Zealand and was designed in collaboration with external investigators Dr George Laking, Dr Susanna Galea and Dr David Newcombe.

For more information contact Professor Chris Bullen (Principal Investigator).

Previous Research Highlights


ASCEND-2 is a three-arm, pragmatic, community-based clinical trial designed to evaluate the effectiveness and safety of combining nicotine patches with a second generation e-cigarette (with and without nicotine) plus behavioural support, on smoking abstinence. The trial protocol is published and available here. The trial found patches plus nicotine e-cigarettes were superior to patches plus nicotine-free e-cigarettes at helping smokers quit smoking. Findings were published in The Lancet Respiratory Medicine.


CASCAID is a three-arm, pragmatic, community-based, non-inferiority trial designed to evaluate the effectiveness and safety of cytisine compared to usual Quitline care (Nicotine patches and/or gum or lozenges). The trial was undertaken between 2011 and 2013 and recruited 1310 participants. The main findings of the trial were published in 2014 the New England Journal of Medicine, and are available here.

Cochrane review

NIHI leads the Cochrane Systematic Review on mobile phone‐based interventions for smoking cessation. The review collates the evidence on the effectiveness of mobile phone‐based smoking cessation interventions. The first review took place in 2009 with updates in 2012, 2016 and another underway currently. For more information please contact Associate Professor Robyn Whittaker.

View the review here.


The LABEL study involved a qualitative study (with seven focus groups) and a four-arm clinical trial (involving 600 people). Both studies investigated the impact of energy labelling of alcoholic beverages on consumers perceptions, and likely purchase and consumption behaviour. A report on each study is hosted on the Health Promotion Agency website: qualitative study and clinical trial.

mCessation handbook for WHO

Associate Prof Robyn Whittaker is an invited expert on the WHO’s ‘Be Healthy Be Mobile’ global mHealth initiative for non-communicable diseases. In particular, Dr Whittaker wrote the first handbook on mCessation that has been used by several countries to implement national or large scale mCessation programmes in collaboration with BHBM. Drs Whittaker and Dobson recently reviewed these implementations and updated the mCessation handbook for the WHO in collaboration with an international expert group. 

SPGeTTI- A Gambling Harm Reduction Study

The goal of this research was to explore and test if using the SPGeTTI app could help participants stop or reduce the gambling harms being experienced.  SPGeTTI was designed to deliver a package of tailored support messages and information to anyone who is, or thinks they may be, experiencing harms from gambling. This project had ethical approval, is registered with ANZCTR and was funded by the Ministry of Health.

There were 5 inter-related phases in the SPGeTTI Phase II project.

  • Estimating smartphone ownership and patterns of use among people with problem gambling. 
  • Estimating likely recruitment, retention and sample size for the trial.
  • Developing content, features and functions.
  • Testing content, features and functions for face validity and acceptability, technical refinement and testing.
  • Evaluating its effectiveness.

To read about the findings of the formative phase, click here.

The final study results are available here. If you want to know more about this study or the new study Manaaki, please email Gayl Humphrey.


This study was NIHI's original text message smoking cessation intervention and was tested in a national RCT in 2002. A Māori version of the text message programme was developed by Māori co-investigators and offered to Māori participants. The trial found that those participants receiving STOMP were twice as likely to quit as those in the control group. STOMP was shown to be as effective for Māori participants as for non-Māori participants. 

This programme was implemented as a national Txt2Quit service run by HSAGlobal and The Quit Group as part of the national MoH-funded cessation programme for many years (until the national cessation contract was changed). It is also still run as KickButts in the USA.

Find out more about the study here

TXTTaofiTapaa (TXT Stop Smoke)

This study involved the adaption and pilot testing of an mCessation tool to support tobacco control goals in Samoa including to increase quit attempts and reduce tobacco use. The study funded by Health Research Council of New Zealand and the New Zealand Ministry of Foreign Affairs and Trade involved extensive formative work in the local Samoan population. This led to the development of TXTTaofiTapaa, an adaption of the STOMP text message smoking cessation programme, which was piloted in 100 people in Samoa. For more information please contact Associate Professor Robyn Whittaker.

Find out more here.