Pacific Nurse Leader and Smoking Cessation Fono Kate Magner, Ministry of Health

The Issue 31% of Pacific peoples in New Zealand identify as smokers Higher smoking rates among younger Pacific peoples 25% of pregnant Pacific women smoke during their pregnancy Smoking rates vary by Pacific ethnicity, with Taokelauan (39%) and Cook Island Maori (35%) having the highest rates 31% of Pacific peoples in New Zealand identify as smokers. This is significantly higher than the general population, of which about 20% are smokers. And so smoking remains a significant source of health inequalities. There is higher smoking prevalence among the younger Pacific age groups, ranging from a quarter of the Fijian population aged 25-30 years to around a half of Tokelauans aged 25- 30 years who smoke Smoking in pregnancy is a serious and significant issue in Pacific communities, where about a quarter of pregnant women smoke during their pregnancy. Basically about 75% of women who smoked before becoming pregnant, continue to smoke during their pregnancy. Important to note that smoking rates vary between different Pacific ethnic groups with Taokelauan (39%) and Cook Island Maori (35%) having the highest rates Tuatua Tika Pacific Tobacco Control Report 2010

Second Hand Smoke 1 in 10 Pacific non-smokers are exposed to second hand smoke in their home, and 1 in 8 in their car, each week 1 in 3 Pacific non smokers are exposed to second hand smoke at work Tuatua Tika Pacific Tobacco Control Report 2010

Harms of Smoking Nicotine is HIGHLY addictive Tobacco use is leading cause of death and disease in New Zealand Cancer Cardiovascular disease Respiratory disease Reproductive effects And others On average people who smoke lose 15 years of life

Do People Want to Stop? 4 in 5 smokers said that they would not smoke if they had their life over again 3 in 5 had tried to quit in the last 5 years 1 in 4 had quit for at least a week in the last 12 months Pacific, Maori and young smokers are as likely to have tried to quit Many people who want to stop are addicted NZ Tobacco Use Survey 2009

Cumulative chances of quitting over time when making one quit attempt per year with and without cessation treatment -Quitting cold turkey is the most common, and least effective way to quit smoking, with a 96% failure rate. -Supported quit attempts with both behavioural support and medication are most likely to be successful. This slide shows the % of smokers who quit if all smokers made one only quit attempt per year from the age of 35. The dark blue bars are that of the ‘cold turkey’ approach. Note what can be achieved when medication (light blue bars) is added and when support and medication are combined In addition, we need to move this curve forward 15 years so that smokers have quit by age 35, thereby reducing over time their lifetime risk to that of non- smokers. So this tells us that when we can join up people who are making a quit attempt up with some advice, support, and or meds, we can help to make their chances of giving up for good more likely. Aveyard and West. Managing Smoking Cessation. BMJ 2007;335:37-41

Nurses are Important! The key to a successful quitting is making a quit attempt in the first place! 1 in 40 smokers will quit just from receiving brief advice to quit from their health care provider A small effect, but important when delivered across the population Health professionals can: Ask people if they smoke Advise on the risks of smoking and benefits of quitting Different messages for different people Understand that quitting can be hard Know that there are treatments that will increase success by up to 300% Provide these treatments

ABC reminds you what to do A - ask whether a person smokes B - give brief advice to quit to all people who smoke and C – make and offer of and refer to cessation treatment New Zealand’s comprehensive approach, which includes this range of options for cessation treatment is set out in the ABC programme. The ABCs highlight the important but different roles played by health care workers and cessation service providers to provide good help for smokers to quit. The ABCs are about addressing smoking with every patient, and ensuring that they get joined up with cessation treatment that works for them. ABC is about Asking every patient if they smoke, providing brief advice to quit, and providing smoking cessation medications and or referring on to more intensive cessation support services.

The Health Target 95% of hospitalised smokers will be provided with advice and help to quit by July 2012. 90% of enrolled patients who smoke and are seen in General Practice, will be provided with advice and help to quit by July 2012. The Government recognises the value of the ABC approach. And while cessation support services have been doing their part for years, it took a health target to get the healthcare sector on board. The health target is that: 95% of hospitalised smokers will be provided with advice and help to quit by July 2012. And in primary care that: 90% of enrolled patients who smoke and are seen in General Practice, will be provided with advice and help to quit by July 2012.

This shows that the target has seen great success. When it first started smoking was sometimes recorded in the patient notes as part of someone's social history but was not consistently screened for, nor addressed in health care settings In Q4 of 2010-11, 85% of hospitalised patients that smoke were offered brief advice to quit smoking so nearly everyone that smokes was offered help to quit in hospitals. Last year 105,000 smokers were identified and 80,000 smokers received brief advice to quit. And the percentages continue to increase. The coverage achieved through the health target is unprecedented for a smoking cessation treatment and extending the health target to Primary care will extend the reach of the intervention tremendously - Indeed we know that aout 94% of patients are enrolled with a GP and about 85% of these will see their GP each year. So the vast majority of the NZ population are likely to be screened for smoking and provided brief advice and help to quit this year, if we achieve the target!

Supporting smokers to quit Cessation focus – more smokers making more quit attempts (supported with evidence based treatments) more often Reliable and routine assessment of smoking status, advice to quit and prescription of NRT or referral to cessation services Investment in national cessation services and in access to NRT and other pharmacotherapies

Resources and Tools You Tube Smoking Cessation ABC e- Learning tool How to use NRT correctly – Dr Hayden McRobbie Smoking Cessation ABC e- Learning tool www.smokingcessationabc.org.nz The hiirc website www.hiirc.org.nz STEPS training Train the trainer Pacific ABC training programme

Conclusions Smoking is a considerable source of health inequalities for Pacific people More quit attempts more often, linked up with more support and treatments Do the ABCs - a 2 minute conversation could change someone’s life

Thank You