Working towards a Smokefree Pacific by 2025

The recent Smokefree Oceania 2013 conference in Auckland, New Zealand, drew together participants from the South Pacific, Australia and New Zealand. The conference was bookended by ebullient speakers anticipating a smokefree South Pacific by 2025. The Honourable Tariana Turia, Associate Minister of Health and champion for the government goal for a Smokefree New Zealand by 2025, opened the conference. She was followed by Dr Temo K Waqanivalu from Fiji, the WHO coordinator for Non Communicable Diseases for the South Pacific. The Pacific Health Ministers agreed that addressing tobacco use is a priority for reducing non-communicable diseases at Apia, Samoa, in July this year. Professor Emeritus Robert Beaglehole closed the conference with steps to achieve the 2025 goal and the promise of a wonderful celebration when it happens.

The buoyant tone permeated the whole conference. The conference showcased the synergistic action of the different facets of tobacco control. Smoking cessation had a high profile since very low prevalence will not be achieved without increasing quit-rates among current smokers. The conference organizers took to heart the inequitable distribution of smoking prevalence. Consequently presentations, workshops, and even the politicians’ panel, referred to action to address smoking rates among Australian aboriginal peoples, New Zealand Maori, Pacific Island peoples, mental health services users, pregnant women and others.

I will now focus on a few presentations of special interest to mainstream health practitioners.  Professor Paul MacDonald’s elegant keynote presentation, “It Takes a Village to Raze Tobacco” drew together results from different fields to support an argument for harnessing social networks to influence quitting. This included evidence that friends of friends of smokers can be influential.  Perhaps we can mention that we know people who have quit or are quitting when conducting brief effect smoking cessation interventions.

Dr Hayden McRobbie’s short presentation was invaluable for health professionals. He mooted a new focus on quitting in young people. Key points were that about 50% of smokers made quit attempts in 2012. Brief interventions help to trigger more quit attempts. The evidence for whether the smokers who remain are highly dependent and find it harder to quit is mixed. Data from the UK show that there is more long term quitting when smokers are under 30 and in older age groups. Because this is not the case for people from lower socio-economic groups a new emphasis on younger smokers may be necessary.

With regard to pregnancy Dr Marewa Glover emphasized that the focus of smoking cessation interventions should be on the health of the baby via a healthy pregnancy for the Mum. She stated that using the stages of change for quitting smoking in pregnancy is not appropriate as the baby’s welfare is paramount. Health professionals must intervene early by giving clear and sound information about the dangers of smoking by personalising the conversation. Brief effective interventions and the offer of evidence-based support (nicotine replacement therapy) are critical every time a nurse or other health professional sees a pregnant woman. Smoking cessation is about protecting children, and also about how the tobacco industry, pedaling an addictive poison to the most vulnerable people, is our enemy and deserving of our community’s animosity.

Tobacco Control Nurses International and Smokefree Nurses Aotearoa/New Zealand conducted a lunchtime seminar. The first presentation (go to 3:02) was about women and tobacco by Emeritus Professor Ruth Bonita.  The second presentation reviewed the evidence for motivational interviewing and how it fits with nursing culture, values and smoking cessation by Dr Mark Wallace-Bell.