QUIT FOR GOOD AUAHI KORE SCHOLARSHIP PROGRAMME Research Project

Whakapapa  Government has a goal to reduce smoking rate in Aotearoa to 5% by 2025  New Zealand Tobacco Control Research Turanga was set up to fund studies which may help to achieve the 2025 goal  University of Auckland funded by MoH and HRC to lead this research programme  Proposal for funding was submitted this time last year to the Turanga Emerging Issues Fund

Smoking rates for Maori  23.8% student nurses (NZNO study 2013)  21% Maori registered nurses (Gifford et al, 2013) Still lower than smoking rates for Maori general population:  33.6 Maori male  38.5 Maori female BUT LOOK smoking rates for non-Maori students nurses 9.75% Smoking rates for non-Maori general population - male 13.9% non-Maori female 13%

Quit for GOOD The name is chosen to reflect the:  goal to remain smokefree once cessation has occurred  health and financial benefits to the individual and their whanau  positive effect on nursing practice  positive role modelling

Kaupapa of the study  To assess financial incentive as a method to achieve smoking cessation among Maori nursing students and their whanau members  Based on a scholarship programme  $1000 Scholarship awarded over a period of 6 months to students who remain quit with their whanau members  Ethics approval gained in March 2014

Mahi  Aukati Kaipaipa enlisted to provide smoking cessation support or whanau free to use other methods, medication, other provider, Quitline etc  Hui attendance required for breath testing and to receive scholarship  Both student and whanau member must test negative for student to receive money  Focus groups would be held at weeks 12 and 20

Results  12 students agreed to participate  1 withdrew after week 1  1 withdrew after week 2  1 left the country at 12 weeks  3 students’ quit mates withdrew at various points  2 students and 1 whanau member joined programme as quitmates 11 students involved in programme

Results continued Smoking cessation measurements based on breath testing and or personal declaration  12 weeks: 3 quit pairs remained quit after week 3  16 and 20 weeks: difficult to measure – tests missed, hui attendance waivered, same 3 pairs remained quit, others had varying results  acknowledged that breath testing not reliable as a measure of smoking cessation  At week 16 introduced personal declaration “I have not had a single puff” – more reliable as students and whanau found it difficult to lie.

Results continued  Weeks 21 – 24: must be quit for the duration measured by personal declaration “I have not had a single puff” and validated by breath test  5 quit pairs remained quit for the 4 weeks including the 3 pairs who remained quit for the 24 week duration of the programme (after week 3)  Programme extension offered to other quit pairs  2 further quit pairs remained quit for the duration between weeks 24-28

Results continued  Budget allocated $10000 for maximum of 10 students  $6750 in total awarded Summary of Focus Group korero

What has been helpful? 12 week Focus groups  NRT  being around people who are also quitting or who don’t smoke  being able to bring our kids to hui  not having any money to buy cigarettes  “its cool hearing everyone’s stories”  “Hearing peoples struggles helps me continue my quitting”  Kapa haka and netball

What has been helpful?  “Internet helps. Facebookers support my journey”  “Um you’re (Evelyn) support rather than the quit team support”  “Stopping for someone that you know, like my mum who is my ‘quit buddy’ kind of makes it more important and more meaningful”  Cuppa tea was more helpful than korero in hui  Small groups (when fewer people attended) were more beneficial

What has been helpful?  “For me what has helped, is being able to go somewhere and know that it is for me giving up smoking, even though it has taken some time to quit, knowing that there is a programme that is willing to tautoko me” Key point: no one mentioned that the scholarship money helped

What has not been helpful  Groups too big  Hui boring – too much talk about smoking make you want to go and have a smoke  “WHAT has NOT helped me is the length of some of our Hui. Um the time, like no structure”  “Talking about smoking”  “I feel like all we do is identify the problems but not really work on how to prevent these problems or how to find a solution for these problems”  “because it was only fortnightly I slowly dropped off”

What has not been helpful?  “Stress, exams and studying”  “Being around other smokers, drinking, my quit mate doesn’t help me he always buys cigarettes”  Trying to change daily routine very difficult especially avoiding the first cigarette on waking  Being around whanau (students, friends and whanau) who ‘slip up’  Drinking alcohol, socialising

Questionnaires  Smoking started between 13 and 19 years  Either both parents or one parent smoked usually mother  All students and whanau have tried between one and several times to quit previously What was helpful?  Having a quitmate – also unhelpful  Knowing that you were being tested  Evelyn catching up with student and buddy

Miscellaneous responses/comments  “when you have done really well you want to go to the hui and talk about it, but when you have not done really well you want to cry”  didn’t realise how much the kids hated us smoking in the car  I needed to use the laundromat to dry the washing because I always had a smoke when hanging the clothes on the line  I’m doing this for my mokos  My household is now smokefree  I used to have a pack a day, now I am down to a smoke a week

Questionnaires  Advice for people trying to quit: Main themes : keep trying, use NRT, have a smokefree home, have a quitmate, think of the physiological effects on your children and yourselves, keep your hands busy Advice for smoking cessation services: Try new things which are visual and practical, closer contact, “stop talking about bad things” focus on harm to whanau, have realistic goals, have incentives, also refer to services that can help with stress and health eating

Your recommendations  Weekly tests  Random tests  Smaller hui numbers  Practical tips to cope with triggers  Simulation – use scenarios to help to develop strategies to resist triggers eg having a cup of coffee  Run a programme like this every year  Stricter protocols around testing smoking status  More one on one support

Your feelings as a student nurse As a smoker or when relapse occurred - guilt, hypocrisy, disappointment, anger, sadness, embarrassment Successful cessation – feel fabulous, can breathe in the mornings, confident, more understanding of others quitting, pride

Is financial incentive an effective way to achieve smoking cessation  Good incentive to come to hui  Many responses stated incentive to begin with  Other factors more important such as doing it for tamariki Last 8 weeks confirm that financial incentive was effective for that period of time

What now  Write up the study  Disseminate findings to stakeholder groups  Submit for publication  Make recommendations for others in this mahi eg Te Runanga  Seek funding/resources to continue similar programme in Nga Ringa Awhina and or Foundation Studies, Pacific students

Acknowledgements  Nga ringa wera  Whaea Mavis  Gloria, Api, Sheree Mango Pare Services  Marewa Glover Turanga Director  The Tobacco Control Research Turanga: A programme of innovative research to halve smoking prevalence in Aotearoa/NZ within a decade

Nga mihi mahana kia koutou katoa nga tauira, nga whanau Kia kaha ki te auahi kore mo ake tonu atu