Today marks 10 years since smoking was banned in bars. Health reporter Martin Johnston looks at the socio-economic factors influencing tobacco use and plans for a smoke-free future

Maori adults living in Auckland's wealthy north Epsom have about the same likelihood of being a daily smoker as their European neighbours - 8 to 9 per cent.

Nip next door to well-heeled Remuera west and disparities start to show up, with 7 per cent of Europeans smoking, compared with 10 per cent of Maori.

Mobile users: Tap here for the full version of the Maori smoking rate infographic.

But then head south to low-income Manurewa central and you will slam into the ethnic smoking gap: the Maori rate, at 40 per cent, is nearly double the European rate, according to the latest national census data on "regular" smokers, those who puff daily.

Advertisement

The picture varies from area to area because of small numbers, but Manurewa central roughly reflects the national Maori/European smoking divide.

Nationally, 32.7 per cent of Maori aged 15 or older smoke, compared with 13.9 per cent of Europeans. Pacific people are on 23.2 per cent, Asians 7.6 per cent - and the whole population, 15.1 per cent.

Slicing the 2013 smoking statistics up by poverty reveals even greater differences. The smoking rate in the most-deprived areas is more than four times greater than in the least-deprived.

By 2013, all major ethnic groups' smoking rates had declined since the preceding Census, in 2006, but the percentage reduction was greater for Europeans than for Maori, a trend present since the 1980s when the national adult smoking rate was 33 per cent and the Government made its first big efforts to get Kiwis to quit.

Researchers say history predisposes Maori to having higher rates of smoking than other ethnic groups in New Zealand, and this is passed on from parents to children like a contagious disease.

Professor of public health Tony Blakely, of Otago University at Wellington, ties this back to the European colonisation of New Zealand and the use of tobacco to buy Maori land.

"A hundred years ago Maori females had very high smoking rates. For non-Maori females it started much later, post-World War II. There has been a longstanding history of high smoking among Maori, which comes back to the way trading was done initially.

"You've got a cultural norm and a contagion ... of smoking transmission."

Advertisement

Professor Blakely said the higher smoking rate of Maori was in part explained by lower socio-economic status - SES, a measure of income, educational level and occupational class - but only to a small extent.

Maori were "coming off a very different history of a very high smoking rate which means you've got further to go down".

"Normally what we see around the world is rich males take up the habit first and drop it first, followed by low-income males who take it up, drop it next, followed by high-income females, then low-income."

New Zealand is largely following the same pattern, although Maori females are an exception.

"There are these waves in smoking going up then going down, and the lower socio-economic groups tend to take it up last then take a long time to give it up. It's just out-of-phase epidemics.

"Why. Because when smoking initially comes into a society it's seen as glamorous and hits the higher socio-economic groups first. Then they realise it's bad for them and give it up first because they have higher levels of education, better knowledge and better income to get quit treatments, although we [the state] do try to subsidise them now."

In a 2003 paper, Professor Blakely and colleagues reported that although smoking rates had declined between 1981 and 1996, ethnic inequalities had widened under the indoor smoking restrictions at many workplaces, the controls on tobacco advertising and other mainstream tobacco control policies of the time.

"These mainstream interventions appear to have been more effective for those population groups who already had the lowest rates of smoking," they wrote.

"Thus the overall prevalence of smoking may have been reduced at the expense of growing inequalities in tobacco use and tobacco-related health outcomes."

It was several years after the 1996 Census before policies were introduced to specifically target Maori smoking (1998), and to make reducing health inequalities a major health goal (in 2000).

Doubts remain about whether New Zealand can meet the Government's target of being a largely smoke-free nation - widely interpreted as a smoking prevalence of less than 5 per cent - by 2025. The latest projections from Professor Blakely's group, published in the New Zealand Medical Journal, predict a European rate of around 7 per cent and Maori rate of 19 per cent, although these figures don't take into account the two 10 per cent tobacco excise tax rises scheduled for next month and 2016.

In an Otago University blog post last month, Professor Blakely and others said that to make achieving the 2025 goal a "reasonably high" probability , annual 10 per cent tax rises would be needed, plus one other big new policy, such as:

Regulating the tobacco market and gradually reducing the supply of tobacco.

Reducing the levels of nicotine - the addictive component - in tobacco to very low levels.

A large reduction in the number of tobacco sellers.

Reducing the number of points of sale could be particularly effective in poor areas, research from Canterbury University suggests.

For his Master of Science thesis in 2011, geography student Christopher Bowie compared Christchurch neighbourhoods on their densities of convenience stores and supermarkets.

"Individuals living in low SES neighbourhoods," he concluded, "have greater access to commercial sources of tobacco products than those living in high SES areas ..."

Analysing Health Sponsorship Council youth smoking research, Mr Bowie also found that while all young smokers overestimated adult smoking prevalence, young smokers at schools in poorer areas over-estimated it the most. Thirty per cent of them believed half of adults were smokers, and 43 per cent put the proportion at three-quarters.

Auckland University tobacco control expert Dr Marewa Glover said these young people's beliefs would have been shaped by what they saw around them in a similar way to how Maori smoking was perpetuated.

Percentage of Aucklanders who are regular smokers

MAORI

EUROPEAN

"More Maori smoke, so more Maori believe it is the norm, and therefore more Maori smoke."

She said many people in lower socio-economic groups were not touched by the 2004 indoor smoking ban at virtually all workplaces including pubs, although they were influenced by tobacco tax rises.

Dr Glover described a feasibility study her group conducted in Northland that engaged community volunteer "aunties" to find pregnant Maori smokers and support them to stop smoking.

The aunties found 67 women. Later checks of medical records showed 24 per cent were not smoking at the time of birth.

A national check in 2010, published in the journal of the College of Midwives, indicated that 43 per cent of pregnant Maori women were smoking when they registered with a midwife and that 21 per cent of them quit during pregnancy.

"The aunties," Dr Glover said, "were able to get into homes associated with gang lifestyles. It's finding people who have access, who know the community and are acceptable to that community to go in and deliver the support."

Associate Health Minister Peseta Sam Lotu-Iiga said the Government was committed to reaching its goal of a Smokefree New Zealand by 2025.

"I am particularly keen to see the rates of Maori and Pacific people smoking decreasing to reduce the massive health problems that smoking causes in our communities," he said.

In 2013/14 the Government budgeted for $66.9 million to be spent on tobacco control activities, up from $57.4 million in 2009/2010.

"New Zealanders have done well over the past few years but clearly there is still a long way to go and much more to do," Mr Lotu-Iiga said.

Mobile version of the interactive:

$5000 incentive helps teams stub out in regional challenge

Rivalry to win the $5000 prize was so hot in Pou Collett's quit-smoking competition that nearly half of the 11 teams ended up with all of their members having stopped puffing.

"That's pretty good; it's awesome," said Lloyd Whiu, a Waikato co-ordinator for Wero, the Whanau End smoking Regional whanau Ora challenge.


Pou Collett. Photo / Christine Cornege

Ten-member teams - mainly Maori, but some Pasifika and Pakeha too - compete to have the greatest number quit for 24 hours at the end of the three-month challenge. The Auckland University staff who oversee the national competitions haven't decided the winner or winners in the challenge entered by 29-year-old Mr Collett's kapa haka group, Motai Tangata Rau.

Mr Collett, a te reo Maori teacher at Te Awamutu Intermediate School, began smoking when he was 13 and said he was surrounded by family members and friends who smoked. Before the competition began he was smoking about 14 cigarettes a day.

The Wero was his fifth attempt to quit. It took him two weeks after the challenge started before he managed to go 24 hours without a smoke.

"It wasn't easy. I found myself getting a bit edgy and craving like crazy. My wife Renee smokes, so smoking is always there. Quitting didn't happen overnight; there were a few slip-ups."

"I used the patches but they didn't work so I just had to use pure will. If anyone had a slip-up we didn't put them down, we just encouraged them to think of the bigger picture for the kapa haka nationals next year."

Wero winners nominate a charity to receive any winnings and Mr Collett's group will put its share of the $5000 and smaller prizes they won towards the kapa haka group's trip to the nationals in Christchurch.

When the Herald spoke to Mr Collett he had been smoke-free for 10 weeks and was liking it, kind of.

"Every now and then I don't feel too good - no, I don't feel too bad. I can taste food better and I'm eating a lot more which is probably not a good sign."

But his breathing has improved and he is saving money. He said he wanted to stay off the smokes for his health and his four children.

Wero programme manager Ingrid Minett said more than 2000 people had taken the challenge. Quit rates checked a month later varied but had been as high as 37 per cent.

"There's two national challenges in 2015, one in April and one in September. We are looking at employers and businesses who want to support their staff, and some smaller regional challenges along with the national ones."