1. Increasing NRT-use among Māori and Pacific smokers Findings of research conducted for the Ministry of Health 2010 Kiri Milne and Michele Grigg

2. Acknowledgements  Māori and Pacific research partners  The Ministry of Health  Health and cessation provider participants  Māori and Pacific smoker participants

3. Identifying the issue  23% of NZ adults smoke (45% Māori, 31% Pacific)  Most smokers want to quit but find it hard  Use of NRT approximately doubles the chances of quitting successfully  Yet most smokers try to quit without using smoking cessation treatments or products  66% of smokers don’t use quitting products or advice when attempting to quit - 34% do  Of those who do use products and advice, 20% use NRT  21% for Maori; 13% for Pacific

4. Research purpose and questions  MOH wants to generate more quit attempts that are supported by treatment, more often  Purpose of research: Improve our understanding of NRT- use, particularly among Māori and Pacific smokers, including: 1.Current use of NRT 2.Influences on use of NRT 3.Approaches to increasing use of NRT  Research undertaken April to August 2010

6. Multi-method research programme 1.Brief review of evidence on access to, and use of, NRT 2.Stock-take of NRT resources targeted at smokers 3.Interviews with health and cessation providers 4.Interviews with Māori and Samoan smokers

7. Use of NRT - access  At 20%, NRT the most commonly used form of quitting support  cf. QL 13% and GPs 6%  Cold turkey most commonly used quit approach  63% of NRT-users access subsidised NRT – over one- third don’t  41% of NRT-users access NRT from the Quitline  cf. 12% from GP and 23% from pharmacy  Some evidence of differential access to NRT for Māori, Pacific and younger smokers

8. Use of NRT – optimal use  Most NRT-users don’t use NRT for recommended length of time  19% QL clients used patches for recommended 8 weeks  Reasons: have quit / used enough to stay quit / achieve what wanted / started smoking / given up trying to quit / don’t like patches / gum

9. Environmental influences on NRT use (1)  Affordability  perceived cost of NRT and GP visit “ I just thought it was extra money. I can just do it myself. Save my money.” (Samoan female)  Acceptability  Look and experience of patches, taste of gum, perception that you’re weak if you have to use NRT “It seems absurd to use patches and gum when, you know, just harden up and give up.” (Samoan male)  Availability  Option of direct distribution preferred by health providers  Get patches/ gum from friends/family – experimental for younger smokers esp? “Mates. Free. It was there.” (Māori male)

10. Environmental influences on NRT use (2)  Availability  Reluctance to go through QL and doctors for NRT “I just want to try patches. I don’t want to talk to anyone about it.” (Māori female ) “Don’t want anyone to know. It’s my problem. I’ll solve it.” (Samoan female)  Information  Varying accuracy, inconsistent, limited accessibility  Few resources aimed specifically at Māori or Pacific smokers  If accessed through friends/family – very poor information “I got them from my mate. I didn’t know you could only use a little bit. I didn’t read the packet. I just put them on anywhere. She said you just stick them on. I just felt really sick.” (Māori female)

11. Individual influences on NRT-use (1)  Awareness and knowledge  Most smokers have some awareness of patches and gum  Poor knowledge of how it works, where to get it, how much it costs, how to use it  Understanding and beliefs  Perceived effectiveness “I think it probably works but not mentally.” (Samoan male) “I wouldn’t buy patches because I don’t see how it works.” (Māori male)  Perceived safety and side-effects

12. Individual influences on NRT-use (2)  Skills and confidence  Anxiety, fear, NRT as a ‘back up’  Confidence in going cold turkey  Adherence  Previous experience of NRT can enhance or hinder use – perception among some that NRT doesn’t work

13. Recommendations Accessibility  Promote (subsidised) NRT, especially price  ‘Take it to the people’ - on site NRT, free trial packs, make more visible  Make accessible through wider range of venues Optimal use  Promote basic facts about NRT – including effectiveness, affordability, how to access it  Trial/sample packs  Demonstrate NRT at point of collection/provision  Streamline resources  Accurate, consistent, practical and targeted messaging

14. Increasing NRT-use among Māori and Pacific smokers

15. Smoker interviews  Focus groups and paired interviews  Participants were:  Current or recently quit smokers  Māori (n=33) and Samoan (n=19)  16-25yrs (n=17) and 26yrs and over (n=35)  Female (n=32) and male (n=20)  Urban (n=38) and provincial (n=14)  Low to mid-SES