In the second of his series on efforts to reduce smoking in NZ, Martin Johnston looks at efforts to target a top-risk group.
Dr Marewa Glover wants more attention paid to addressing the alarmingly high number of Maori women who smoke.
While there has been a marked reduction in smoking among teenagers, including Maori - which health officials expect will lead to a reduction in the number of adults smoking - the number of Maori women who smoke remains high at just under 50 per cent.
This is far higher than the 20 per cent smoking rate for the whole population aged 15 to 64. It is also higher than Maori men, who, at 40 per cent, are the next highest smoking group, based on ethnicity and gender.
Not surprisingly, the high Maori smoking rate leads to high death rates from diseases caused by smoking. The death rate from lung cancer among Maori women is more than 4 times the non-Maori rate.
The primary concern for Dr Glover, the director of the Tobacco Control Research Centre at Auckland University, is Maori women of child-bearing age, because tobacco smoke harms a pregnant woman and her fetus.
She lists the risks to the child - miscarriage, stillbirth, premature birth, low birth-weight, sudden unexpected death in infancy, respiratory illness and, later, taking up smoking.
College of Midwives adviser Alison Eddy said many smokers who were not heavily addicted often quit when they found they were pregnant, meaning those who were still smoking at the point of engaging a midwife were probably heavily addicted to nicotine.
At this point, a college survey shows, about 45 per cent of pregnant Maori women are smokers.
This drops to 29 per cent when the baby is born, mirroring the reduction during pregnancy when all ethnicities are counted together.
But the Maori rate of smoking in pregnancy is more than twice that for all women.
Dr Glover said: "Our absolute priority group in New Zealand has got to be Maori pregnant women who smoke. That means we have to reduce smoking prevalence among Maori women, particularly of child-bearing age."
Some Maori were fine to use the national Quitline; others needed specialised Maori services.
Dr Glover said some of the Maori services received a level of funding that was disproportionately low for the population they were expected to serve.
This left them with "barely a workforce" to do the job.
She was amazed that some social marketing campaigns seemed to have ignored Maori women.
She cited one that aimed, because of the role-modelling power of parents, to encourage parents not to smoke in front on their children.
"The ad had a white man and a white son. Our priority should be Maori women of child-bearing age with children. Why not use a Maori woman with a Maori child."
One of the Health Ministry's strategies to reduce smoking prevalence is for health workers to regularly ask patients about smoking, encourage smokers to quit and offer cessation therapies.
Its top priority groups for this are Maori and Pacific people, pregnant women and parents.
Quit-smoking services are being reviewed, at the instigation of Associate Health Minister Tariana Turia, whose Maori Party wants the Government to strengthen tobacco control policies.
An acting deputy director-general at the ministry, Ashley Bloomfield, said the review had looked at all state-funded services.
"We want to increase the range and effectiveness of those services. An evaluation of Quitline shows it's very effective and cost-effective. We're trying to increase its delivery for Pacific people."
When asked about the findings on Maori services, he cited the programme Aukati Kaipaipa, used by many iwi providers.
"Some are going very well; others we are trying to improve their reach and delivery."
Aukati Kaipaipa is an intensive quit-smoking programme primarily for Maori and provided by Maori.
Free to clients, it is based on nicotine replacement therapy and motivational interviewing - in a Maori context. It usually involves weekly face-to-face meetings with a quit coach for eight to 12 weeks, plus texts or phone calls between visits if required. But because smokers need on average 14 quitting attempts to succeed, some stay on the programme longer than 12 weeks.
It began in 1999 as a two-year pilot, aimed particularly at Maori women. An evaluation of the pilot for the ministry found it significantly increased the quit rate. The programme cost between $4310 and $5715 per quitter.
Te Hotu Manawa Maori provides training and its executive director Moana Tane said Aukati Kaipaipa was effective for many people.
* Where it's banned
Countries which have laws banning retail tobacco displays:
Britain (comes into effect next year).
Canada (most provinces/territories ban displays at point of sale, progressively since 2001).
Finland (from this year ).
Australia (most states/territories, this year and next).
Not New Zealand.
Source: Action on Smoking and Health