1. Social Marketing of Smoke-free Homes: Impacts for Maori Caregivers Stella McGough, MSc – The Quit Group Mere Wilson, BCA BA – HSC

2. Outline 1. Second-hand smoke (SHS) exposure in New Zealand 2. Campaign development, programme planning and evaluation 3. Campaign in action 4. Stakeholder perceptions 5. Impacts associated with Smokefree Homes 6. Learnings and conclusions

3. The problem of SHS SHS contains more than 4,000 chemicals, including 50 that are known to cause cancer Strong associations between exposure to SHS and increased risk of illness/death Children are particularly vulnerable to the negative effects of SHS – via biological and social factors Where there’s smoke, there’s someone role- modelling smoking behaviour

4. Exposure to SHS: New Zealand December 2004: Further amendments made to the Smoke-free Environments Act (1990) Need for protection of non-smokers in private settings Substantial proportion of New Zealanders still smoke – relatively higher prevalence among Maori Baseline population survey conducted in 2003: 7-day point prevalence for Maori caregivers 34% 7-day point prevalence for non-Maori caregivers 18%

5. The process 1. Establishment of Reference Group 2. Formative research: 1.Literature review 2.Interviews with smoking parents and caregivers 3.Baseline population survey 4.Concept testing 3.Development of the campaign plan

6. Parameters Target group – ‘children’ –Need for protection / have most to gain –Smoking around children linked to youth uptake Priority groups = groups most at risk of being exposed to SHS: –Smokers / smoking households –Maori households –Low socio-economic status households + Households with children aged 2 – 13 years

7. Parameters cont. Setting – ‘homes and cars’ –Primary setting for SHS exposure of children Intervention group – ‘parents and caregivers’ = group most able to effect change with respect to children’s exposure to SHS in homes and cars –Particularly those who smoke (within priority groups)

8. Overall Programme Plan

9. Goal: Increase the number of parents and caregivers implementing and enforcing strategies to reduce exposure of children to SHS in homes and cars

10. Objectives Motivation Knowledge of strategies Confidence Support Cessation Equitable benefits for Maori

11. Strategies 1. Mass communications –communicating at population level - TVC, Radio Ads, national print magazines, website 2. Supporting community action –supporting local activities that promote smokefree homes and cars messages - number of resources developed.

12. TVC development 1. Creative brief 2. Concept development 3. Concept testing (part of formative research) 4. Development of campaign material –TVCs, print ads, radio ads, posters, pamphlets, resources etc 5. Dissemination planning i.e. booking media, identifying how resources should be distributed

13. TVC Concept testing Focus Groups –52% Maori, 41% Pakeha –Current Smokers, aged 18-65 –Parents/ Caregivers to children aged 2-13yrs –Identified themselves as smoking inside their homes –Mid to low socio-economic –8 groups, 2.5hrs long –4 concepts were tested.

14. TVC Concept testing - Results These results informed the further dvpt of TVC, but also supporting resources. –Strapline - Take it outside to Take the smoke outside –Use of tikanga - “ You don’t combine smoking and carving, it’s tikanga, it’s just not done.” (Maori, female, Urban) –Not explicity targeting by ethnicity - “ They’re using Maori, those bloody Maori, here we go, they’re just trying to target one race. Every time I see a commercial like that, it’s just another thing going on about Maori again.” (Maori, female, Urban) “ We’re always only on the negative [advertisements], all these bad things, we’re on the news all the time.” (Maori, female, Rural/Provincial)

15. TVC - Problem

16. TVC - Solution

17. Strategy 2: Community action Aims: 1. To get Smokefree Homes on community health workers’ agendas 2. To support community action that promotes Smokefree Homes

18. Involving the Workforce Presentations at regional / community health worker meetings Campaign website Campaign resources –Posters, pamphlets, key-rings, fridge magnets, stickers etc Opportunities for integrating national / regional / local initiatives with Smokefree Homes campaign e.g. WSFD 04 and 05

21. Impacts associated with the Smokefree Homes Campaign

22. Key research Public response to the Smokefree Homes campaign 7-day point prevalence of exposure to SHS in the home Further validation from self-reported smoking restrictions in the home

23. Awareness and Perceptions Unprompted awareness of any of the three Smokefree Homes TVCs: ≡19% Prompted awareness of the awareness- raising Poisons TVC: 70% Prompted awareness of the solution- focused Take the Smoke Outside TVC: 73%

24. Prompted Awareness

25. Engagement: Poisons TVC All Maori interviewed (n=1019) Only Maori caregivers (n=321) vs 30.9 vs 40.4 vs 37.9 vs 39.1

26. Engagement: TTSO TVC All Maori interviewed (n=1019) Only Maori Caregivers (n=321) vs 26.2 vs 42.2 vs 27.6 vs 38.7

27. SHS exposure in the home

28. Allow smoking in the home

29. Learnings and conclusions Follow standard Social Marketing practice: ask your audience! Get inside their heads. Act on the feedback you receive! Resources: not all of the ideas worked in our communities Gain leverage from other agencies / initiatives if you can -example: Asthma campaign Change may happen slowly – make your evaluation tools sensitive to that (a Programme Plan helps)

30. Acknowledgements Campaign Reference Group: Te Hotu Manawa Maori, New Zealand Heart Foundation, Action on Smoking and Health (ASH), Smokefree Coalition, Aparangi Tautoko Auahi Kore (ATAK now Te Reo Marama), Aukati Kai Paipa, Smokefree Pacific Action Network (SPAN), Wellington School of Medicine Department of Public Health Trevor Shailer, Anaru Waa Research participants of the concept testing and population surveys TNS and Gravitas Research and Strategy who conducted the fieldwork for the population surveys Kiri Milne – for providing material for this presentation

31. Smokefree Homes campaign Contacts:Websites: Marija Vidovichwww.secondhandsmoke.co.nzwww.secondhandsmoke.co.nz Smokefree Community, HSCwww.auahikore.org.nzwww.auahikore.org.nz marija@hsc.org.nzwww.quit.org.nz Mere Wilson Auahi Kore Programme, HSC mere@hsc.org.nz Stella McGough, Researcher, The Quit Group (formerly of HSC) stella@quit.org.nz