Thirty Years of New Zealand Smoking Advances a Case for Cultural Epidemiology and Cultural Geography

This chapter builds upon a recent series of analyses using the New Zealand census on smoking, which indicates a slowing in the anticipated population-wide declines in smoking with entrenched and growing inequalities between socioeconomic, ethnic, and sex groups over 30 years. These two trends have been explained in part as the responses by marginalized groups to specific policy and commercial contexts. Using the same data, we provide a new life course analysis of successive cohorts since 1976, which indicates a hitherto unexplained sex, ethnic, and place variability in "smoking careers" as well as some common patterns. The range of behaviors supports a proposition that socioeconomic factors explain only part of smoking inequalities and indicate that groups interpret and respond to shared contexts in culturally specific ways. More sophisticated research designs are required to explain contextual influences over subpopulation behaviors, and recent insights into the contagious spread of behaviors and norms among group members over large distances highlight the relevance of the nascent fields of cultural epidemiology and cultural geography. Mixed method designs are required to augment multiple statistical level designs before we can know the intersecting set of determinants to health behaviors.