evaluation of culturally appropriate smoking cessation

Evaluation of Culturally Appropriate Smoking Cessation

Programme for Mäori Women and their Whänau

Aukati Kai Paipa 2000

The carver of the tohu on the front cover of this publication was John Clark. John is the nephew of Desley Austen who is the Aukati Kai Paipa Co-ordinator and now a Service Manager at Te Hauora o te Hiku o te Ika.

At the time, John was making the transition back into the community following a period of confinement and Desley asked him to carve the tohu as a way of encouraging him to use his talents for this particular kaupapa, which is making a positive impact on and difference to whänau, hapü and iwi. Desley also saw this mahi as an opportunity for John to make a difference personally by contributing to a local, regional and national hauora Mäori initiative.

The tohu was presented by AKP Te Hauora o te Hiku o te Ika to the pilot sites in Russell on 9 June 2000. It represents the tying-together of the seven Aukati Kai Paipa pilot sites. The leaves on the underside represent the older generation moving on, and the young fronds represent our next generation being smokefree.

Published in April 2003 by the Ministry of Health

PO Box 5013, Wellington, New Zealand

ISBN 0-478-25625-5 (Book) ISBN 0-478-25626-4 (Website)

HP 3622

This document is available on the Ministry of Health’s website: http://www.moh.govt.nz

Evaluation of culturally appropriate smoking cessation programme iii for Mäori women and their whänau: Aukati Kai Paipa 2000

Acknowledgements The evaluation team would like to acknowledge those individuals and organisations who have been involved in the evaluation of the Aukati Kai Paipa 2000 pilot programme. To those who participated in the consultation process, we thank you for your valuable comments and contribution to this evaluation. To the quit coaches, co-ordinators, data administrators, managers and Aukati Kai Paipa Providers, we thank you for your assistance in carrying out activities essential to the evaluation and for your hospitality during our visits. To Sue Taylor of Te Hotu Manawa Mäori, we would like to thank you particularly for the wonderful role you have played in co-ordinating, building and bringing together the Aukati Whänau Whanui. Our thanks go to Dr Marewa Glover for her expertise, guidance and encouragement. Importantly, our thanks go to the clients who have participated in the study. The evaluation would not have been possible without your support. Special thanks also to those people who took part in the baseline survey. We are especially grateful to the kaumätua who have supported us throughout this project. Thanks go to those of you who were able to be present at our hui. We thank you for keeping us all safe and warm, and for your guidance and aroha. We would also like to thank Nick Wilson who provided advice at various times including reviewing the final report. Finally, we would like to acknowledge the support of Mary McCulloch of the Ministry of Health/Health Funding Authority and Joe O’Neill of Novartis. This evaluation has been fully funded by the Ministry of Health. He mihi tenei ki a koutou te hunga tautoko i te mahi rangahau nei. Ko te tumanako ma tenei mahi ka kitea he ara hei whakapai ake i te hauora o te iwi Mäori whanui. Kia ora mai tatou katoa.

iv Evaluation of culturally appropriate smoking cessation programme for Mäori women and their whänau: Aukati Kai Paipa 2000

He Ngeri Na Pania Roa

Ngati Maniapoto, Ngati Porou

Kia hoki nga mahara ki mua I te taenga mai o te päkehä My thoughts return to a time prior to the arrival of the Päkehä when the Mäori was a well developed race.

Pakari te tinana Mäori I te kai totika, I te kai hau oranga

Indeed it was because he/she ate a nutritionally-balanced diet that gave energy and inspired a prominent zest for life.

Mauria tika mai nga kai kino ki Aotearoa I Aha ha

When the Päkehä arrived to New Zealand they brought some very adverse foods. Yes indeed.

He waipiro, he tote, he huka, me te taniwha tupeka Foods such as alcohol, salt, sugar and the most destructive demon of them all, tobacco.

Ka mate I te mate pupuhi tinana mate manawa mate huka,

So followed the pernicious health problems of the Mäori, gout, heart disease, diabetes,

Mate ia tote, mate huango me nga momo mate pukupuku e high blood pressure, asthma plus the myriad forms of cancer.

He aitua, He parekura

Indeed it was a catastrophe. An absolute massacre to this noble race of people.

Ia tau nui noa atu I te rua ngahuru orau o te manake Every year more then 20 percent of Mäori women die from-smoking related illnesses

Ka mate I te kai paipa. Aue Aue te mataku e

Such a senseless waste of life. Yet out of the darkness came the evolution

Whakatau mai te tupuranga o te manu taupua of a new era, tis a dawning of a new millennium in smoking cessation.

Aukati Kai Paipa rua mano e, Aukati Kai Paipa rua mano e

A time for change, change in the consciousness of the Mäori people, a change inspired and driven by a celestial bird.

Koia ra, Koia ra, he manaaki, he tiaki, he tautoko, he mohio

Its quintessence is respect, kindness, guardianship, support, knowledge,

Koia ra, Koia ra, he whakapono, he manaako, he aroha Righteousness, truth, faith, hope, eternal love

he tukuwairua tangata ki te ora

and the will to transcend one’s spirit into the world of light.

Whakanuia hei parehuia!! Whakarangatira kia whakahirahira!! Let us celebrate and exalt the life works of this celestial bird and let its vibrant feathers be worn as heirloom for

all to see.

Riterite te ara o te ora mo nga reanga e heke mai ana The journey has been set and we must pave the pathway for our future generations that are yet to come.

Te Iwi Mäori, OI EKE!! OI EKE!!

(So my illustrious people) Rise up, ascend!!

Te Iwi Mäori, MAREWA!! MAREWA!! Fly upwards and soar, oh celestial bird.

E ko_ koia te ara e

So it is to be!!

Evaluation of culturally appropriate smoking cessation programme v for Mäori women and their whänau: Aukati Kai Paipa 2000

Glossary The following is a glossary of Mäori terms used in this report. On the following page is a glossary of English terms.

auahi kore smokefree hapü pregnant; sub-tribe hui meeting hongi pressing noses (Mäori greeting) iwi tribe kapa haka cultural performance karakia prayer, blessing koha gift kaiawhina assistant kaumatua elder kohanga, kohanga reo Mäori pre-school ‘language nests’ kuia female elder koroua male elder kura kaupapa Mäori Mäori immersion school manaaki, manaakitanga hospitality Mäoritanga Mäori culture manuhiri visitor marae meeting house mokopuna (moko) grandchild panui notice, newsletter (flyer) powhiri formal welcome rangatahi youth röpü group tane male tangihanga funeral rites, mourning ceremony tamariki children Te Hotu Manawa Mäori training/co-ordination organisation for programme te reo Mäori Mäori language tikanga protocol, custom tuakana older sibling teina younger sibling wahine female waiata song wairua spirit waka, waka ama canoe/car, canoeing whakataukii proverb whakawhänaungatanga building relationships whänau customary Mäori extended family whaea older mother, aunt whare house

vi Evaluation of culturally appropriate smoking cessation programme for Mäori women and their whänau: Aukati Kai Paipa 2000

CEO Chief Executive Officer continuous quit rate This measure was not used in this evaluation. It is the proportion

remaining quit over a continuous period (eg, from start day to 12 months, or from end of using Nicotine Replacement Therapy to 12 months). This measure can allow for ‘slip ups’ (eg, no more than one cigarette on two consecutive days).

FTE Full-time Equivalent, ie, a reference to number of staffing positions (full-time or part-time positions that add up to the equivalent of full-time positions).

GP General Practitioner/Doctor HFA Health Funding Authority – health service purchasing arm of the

Ministry of Health until 2001. This responsibility is now a part of the Ministry of Health.

Nicobrevin Nicotine Replacement Therapy brand name produced by the drug company, Novartis.

Novartis The drug company that produces Nicobrevin (nicotine patches and gum products).

NRT or Nicotine Replacement Therapy

The nicotine patches and gum products used to deliver nicotine to participants on Aukati Kai Paipa 2000 during the period of their quit attempt. Nicotine Replacement Therapy can also be delivered via nasal spray or an inhaler. Neither of these were used in this pilot programme.

PHARMAC Pharmaceutical Management Agency Limited – a Crown Entity accountable to the Ministry of Health, which has sole responsibility for managing the New Zealand Pharmaceutical Schedule on behalf of the Crown. The New Zealand Government’s Drug Purchasing Agency.

pilot provider Mäori health services providing the Aukati Kai Paipa 2000 pilot programme.

Point Prevalence Quit Rate A self-reported point prevalence quit rate was used in this evaluation. It is the proportion quit at a set point in time (ie, ‘not smoked for two days’). See Appendix A, and section 5.2.1 of this report, for more details.

quit coach The health team personnel directly responsible for providing nicotine patches and gum as well as support/advice/coaching to participants.

RFP Request For Proposal document – a document produced by the Ministry sent to a short list of providers requesting a detailed description of how they intend to deliver a service.

ROI Registration of Interest document – a document produced by service providers in response to the Ministry’s invitation to register their interest in delivering a specific service. It includes basic organisation information, service delivery experience etc.

Service Description A document produced by service providers in response to the Ministry’s request for a proposal.

SHS Second Hand Smoke, ie, smoke produced by smoking tobacco (includes both the smoke produced directly from the burning cigarette/pipe and smoke breathed out by the smoker).

Evaluation of culturally appropriate smoking cessation programme vii for Mäori women and their whänau: Aukati Kai Paipa 2000

Contents

Acknowledgements iii

He Ngeri iv

Glossary v

Executive Summary ix

Detailed Summary 1

1 An Introduction to the Aukati Kai Paipa 2000 Pilot Programme 12

1.1 Overview of Aukati Kai Paipa 2000 12

1.2 The Aukati Kai Paipa 2000 model 16

1.3 The special nature of Aukati Kai Paipa 2000 – the Mäori approach to smoking cessation 18

1.4 Tobacco control context in New Zealand during the pilot period 22

2 The Evaluation Methodology 23

2.1 Evaluation objectives 23

2.2 The evaluation approach 24

2.3 Strengths and limitations of the evaluation 29

3 The Establishment and Implementation of Aukati Kai Paipa 2000 31

3.1 The HFA/PHARMAC Steering Group and the Advisory Group 31

3.2 Funding the pilot programme 32

3.3 The providers 32

3.4 The training/co-ordination component 33

4 Issues Faced in Implementing Aukati Kai Paipa 2000 34

4.1 Identifying appropriate (motivated) participants 34

4.2 Issues related to the use of Nicotine Replacement Therapy 35

4.3 Considerations of working with hapü women 36

4.4 Working within Mäori settings 36

4.5 Mäori workforce capacity 37

4.6 Mäori workforce development 38

4.7 The pilot providers’ role in data collection 38

viii Evaluation of culturally appropriate smoking cessation programme for Mäori women and their whänau: Aukati Kai Paipa 2000

5 Outcomes of the Aukati Kai Paipa 2000 Pilot Programme 40

5.1 Stories of whänau (Mäori participants and quit coaches) 41

5.2 The programme reduced smoking prevalence and tobacco consumption 42

5.3 The programme delivered both Nicotine Replacement Therapy and counselling to Mäori 47

5.4 Was the programme acceptable? Evidence of how accessible and culturally appropriate it was for Mäori 51

5.5 The programme was accessed by diverse Mäori communities 57

5.6 Cost information – estimate of cost per quitter 59

5.7 How does Aukati Kai Paipa 2000 compare? 64

6 Discussion 70

6.1 The quit rate achieved indicates that the programme is a success 70

6.2 Self-reported quit measure is an appropriate and reliable measure for this evaluation 72

6.3 Reliability and validity of evaluation data 73

6.4 Impact of other cessation/tobacco control activities on the outcome of this programme 74

6.5 Access and elimination of barriers to access 74

6.6 Empowering participants to seek support for their quit attempt 75

6.7 Participants’ judgement of the helpfulness of the programme 75

6.8 Efficacy of Nicotine Replacement Therapy 76

6.9 Efficacy of attempts to quit with close whänau 77

6.10 Impact on levels of second-hand smoke 77

6.11 Issues to take into account in a possible extension 78

6.12 Relative value of this type of programme 80

7 Conclusions 82

7.1 Overview 82

7.2 Extending the programme 83

7.3 Recommended programme provider 85

References 87

Appendices Appendix A: Evaluation of Aukati Kai Paipa 2000 89

Appendix B: Aukati Kai Paipa 2000 Model – in Detail 102

Appendix C: Technical Information about the Data 105

Appendix D: Aukati Kai Paipa 2000 Data Tables 110

Appendix E: Baseline Survey of Mäori Women not on Aukati Kai Paipa 2000 – Data Tables 145

Appendix F: Personnel Involved in Aukati Kai Paipa 2000 Pilot Programme 173

Evaluation of culturally appropriate smoking cessation programme ix for Mäori women and their whänau: Aukati Kai Paipa 2000

Executive Summary

A unique smoking cessation programme for Mäori women This smoking cessation pilot programme for Mäori women and their whänau (Aukati Kai Paipa 2000) was developed to test the viability of implementing a proven, effective smoking cessation intervention in a Mäori health setting. The pilot programme ran for two years from mid-1999, primarily targeting Mäori women. This free service provided Nicotine Replacement Therapy in the form of skin patches and/or chewable gum, together with counselling support delivered by Mäori quit coaches over a period of up to 12 months. The specific objectives of the pilot programme and this evaluation were:

• to determine whether it reduced smoking prevalence, was an effective channel for delivering this intervention, was culturally acceptable, and was likely to be relatively cost effective

• to inform decisions about possible expansion of the programme following the pilot.

Overview of Aukati Kai Paipa 2000 outcomes • Appropriate and accessible for Mäori. The programme is acceptable to Mäori

participants, accessible and culturally appropriate.

• The programme is especially effective for Mäori. The quit rate achieved by Aukati Kai Paipa 2000 is significantly higher than the quit rate recorded for Mäori women smokers in the general population. Furthermore, given the sociodemographic characteristics and smoking/addiction profile of participants, the programme should be viewed as especially successful.

• Aukati Kai Paipa 2000 is likely to be cost-effective. The cost of delivering Aukati Kai Paipa 2000 has been calculated by collecting and analysing data from one pilot provider. The cost per quitter has been calculated to be approximately $4310 to $5715. It will be important in any decision-making about the relative cost effectiveness of Aukati Kai Paipa 2000 to consider that the programme has reached a ‘hard-to-reach’ group who tend not to access other services.

x Evaluation of culturally appropriate smoking cessation programme for Mäori women and their whänau: Aukati Kai Paipa 2000

Expansion of Aukati Kai Paipa programmes The evaluation shows that this programme is effective for Mäori and is therefore a good candidate for a planned expansion. We recommend that the Aukati Kai Paipa programme is:

• expanded to include regions of high need (ie, high Mäori populations, high smoking prevalence)

• provided in a holistic Mäori health service setting, by a Mäori smokefree workforce

• able to maintain its diversity through purchasing from a range of Mäori providers

• delivered as an intensive programme that includes free Nicotine Replacement Therapy and long-term support as key parts of the service

• focused on specific Mäori groups (eg, those over 30 years old, wähine hapü). A number of issues need to be considered in regard to any programme expansion. These include Mäori provider availability and Mäori workforce capacity/development, quality control (standardised protocols, monitoring and governance), working with wähine hapü and appropriate resourcing.

How does Aukati Kai Paipa 2000 compare? The quit rate for Aukati Kai Paipa 2000 is significantly higher than the latent quit rate at 29% versus 12.5%.

Evaluation of culturally appropriate smoking cessation programme 1 for Mäori women and their whänau: Aukati Kai Paipa 2000

Detailed Summary

An introduction to Aukati Kai Paipa 2000 The Aukati Kai Paipa 2000 pilot programme (Aukati Kai Paipa 2000) was developed to test the viability of implementing an internationally proven, effective smoking cessation intervention in a Mäori health setting. Smoking cessation programmes that combine counselling with Nicotine Replacement Therapy have been shown to be particularly effective (Smoking Cessation Clinical Practice Guideline Panel and Staff 1996).1 However, no cessation programmes of this kind had ever been delivered specifically to Mäori by Mäori (Health Funding Authority 1998). Aukati Kai Paipa 2000 primarily targeted Mäori women, and involved the provision of Nicotine Replacement Therapy in the form of chewable gum and/or skin patches, together with counselling delivered by quit coaches. The programme and cessation products were provided free of charge. Aukati Kai Paipa 2000 ran as a pilot for two years from mid-1999 and was delivered in a Mäori health setting at seven locations. During the two years of the pilot over 3200 Mäori women and their whänau participated in the programme and evaluation.

Pilot objectives The overarching objective of Aukati Kai Paipa 2000 was to confirm that a smoking cessation intervention utilising a combined Nicotine Replacement Therapy and counselling approach in a Mäori setting would be effective2 for Mäori and, in particular, for Mäori women and their whänau. The specific objectives of Aukati Kai Paipa 2000 were therefore to:

• determine whether the intervention was effective in a Mäori setting (targeting Mäori women and their whänau aged 18 and over)

• inform decisions about possibly expanding the programme following the pilot period

• identify on what basis such an expansion should be undertaken.

1 The American guidelines for smoking cessation encourage the use of Nicotine Replacement Therapy and recommend

that this be followed by regular counselling sessions with participants. 2 In addition to decreasing smoking prevalence and tobacco consumption, a key aspect of confirming the effectiveness

of the intervention for Mäori was to determine whether the intervention would be acceptable (ie, accessible, culturally appropriate etc) to Mäori women and their whänau.

2 Evaluation of culturally appropriate smoking cessation programme for Mäori women and their whänau: Aukati Kai Paipa 2000

Indicators of success for the pilot programme Given the objectives of Aukati Kai Paipa 2000, four success indicators were agreed for the pilot programme following consultation with key stakeholders:

1. A reduction in smoking prevalence for Mäori women on the programme achieved and maintained for three, six, and 12 months after enrolment as compared to Mäori women smokers not on the programme.3 Secondarily, for those not quit at 12 months, a reduction in tobacco consumption over the 12-month period.

2. A reduction in smoking prevalence for whänau of Mäori women on the programme achieved and maintained three, six, and 12 months after enrolment (ie, a reduction significantly greater than the latent quit rate – see Footnote 3). Secondarily, for those not quit at 12 months, a reduction in tobacco consumption over the 12-month period.

3. That Aukati Kai Paipa 2000 be acceptable to Mäori women participating in the programme (ie, perceived as acceptable by participants, shown to be accessible to Mäori women and their whänau, and shown to be culturally appropriate [Ministry of Health 1995]4).

4. That Aukati Kai Paipa 2000 be a relatively cost-effective5 means of reducing smoking prevalence among Mäori women.

Evaluation objectives Given the success indicators for the programme, the key objectives of the evaluation were as follows.

1. To confirm6 that Aukati Kai Paipa 2000 was effective in reducing smoking prevalence and (secondarily) in reducing tobacco consumption among Mäori women smokers and whänau on the programme. That is, they achieved a quit rate significantly higher than the latent quit rate measured by the baseline survey (see Footnote 3).

2. To determine whether Aukati Kai Paipa 2000 was an effective channel for delivering Nicotine Replacement Therapy and counselling to Mäori women smokers and their whänau. That is, participants were able to easily access the programme and utilise the Nicotine Replacement Therapy and counselling.

3 A telephone survey of Mäori women smokers not on Aukati Kai Paipa 2000 was carried out as part of the evaluation

(baseline survey). This determined the ‘latent quit rate’ for Mäori women smokers over a 12-month period as a comparison to the quit rate of Mäori women smokers on the programme. A significantly higher quit rate among Mäori women and whänau on the programme compared to the latent quit rate would indicate success.

4 In considering whether the pilot programme was culturally appropriate for Mäori we adopted the He Taura Tieke framework for measuring effective health services for Mäori.

5 Relative to alternative New Zealand smoking cessation interventions for Mäori women smokers. 6 Given that internationally this intervention (counselling and Nicotine Replacement Therapy) is a known effective

intervention, the focus of the evaluation was to confirm that the intervention could reduce smoking prevalence for Mäori women smokers and their whänau.


3. To assess the acceptability of Aukati Kai Paipa 2000 as a programme that utilised a combined Nicotine Replacement Therapy and counselling approach in a Mäori setting. That is, to determine whether it was perceived as acceptable by participants, was accessible, and was culturally appropriate.7

4. To collect data to inform an analysis of the relative cost-effectiveness8 of the Aukati

Kai Paipa 2000 programme. To present an estimate of the cost per quitter on Aukati Kai Paipa 2000.

An additional objective of the evaluation was to identify the typical barriers to the delivery of the programme in a Mäori setting, identify critical success factors of an effective programme, and to describe the ideal provider. In addition to data on effectiveness and acceptability of the programme, this information would further inform decisions about the possible expansion of the programme following the pilot period.

Evaluation methodology The evaluation was designed and delivered using a Mäori-focused approach. The evaluation had process evaluation components (including formative feedback to pilot providers), in which the programme delivery was fully described, and outcome evaluation components, in which the programme outcomes were measured (quit rate, reduction in tobacco consumption and cost per quitter).

The establishment and implementation of Aukati Kai Paipa 2000 A Health Funding Authority/Pharmaceutical Management Agency Limited (HFA/ PHARMAC) Steering Group for Aukati Kai Paipa 2000 conceptualised the pilot programme. An advisory group of Mäori, Public Health, Auahi Kore (Smokefree) and smoking cessation experts was formed to advise the steering group on the ideal design of the pilot programme (consideration was given to smoking cessation best practice as well as the need for the programme to be appropriate for Mäori). The steering group purchased the pilot programme (from seven Mäori health providers), the pharmaceutical service (supply of Nicotine Replacement Therapy), the training and co-ordination component (from Te Hotu Mänawa Mäori), and the evaluation of the pilot programme (a joint venture of Mäori and mainstream teams). Almost all of the Mäori health providers were originally set up by Mäori and selected to provide Aukati Kai Paipa 2000, at the time of selection, all were owned/governed by Mäori bodies. The establishment process to this point took a little longer than anticipated, and included all of the financial year 1998/1999 through to April/May 1999. As a result, provider training and programme delivery commenced in staggered waves around the country from May to August 1999 (BRC Marketing & Social Research and Te Pümanawa Hauora 2001; Health Funding Authority 1998).9 7 In considering whether the pilot programme was culturally appropriate for Mäori we adopted the He Taura Tieke

framework for measuring effective health services for Mäori. See Section 5.4 for further explanation of this. 8 Relative to alternative smoking cessation interventions in New Zealand. 9 See the earlier process focused evaluation report and the Purchasing Framework for more details.


The following factors contributed to the successful establishment and implementation of Aukati Kai Paipa 2000. Some factors relate to the way the programme providers were supported.

• The training and co-ordination component was identified as a key success of the implementation of the programme because it enabled the close monitoring of providers’ progress and identified gaps in providers’ expertise which could then be addressed.

• Whakawhänaungatanga between pilot providers. Co-ordination included regular hui of key stakeholders (all seven pilot providers, the trainer/co-ordinator, the key HFA contact, and the evaluators). These hui allowed a collaborative approach in which the programme evolved to include protocols and processes that were both Mäori-appropriate, that met the health sector standards and were agreed with and understood by all parties.

Many of the factors that contributed to the successful establishment and implementation of Aukati Kai Paipa 2000 were programme features that enhance the acceptability of the programme for Mäori.

• Operated in a Mäori setting. It was delivered to Mäori by Mäori.

• Diversity in delivery of the programme. Each pilot provider adapted the programme to cater for the needs and expectations of their local Mäori community thus reflecting the social and cultural diversity of Mäori (Durie 1994).10

• Delivery within a holistic health and social service setting. This meant that the programme was able to cater to Mäori clients who tend to expect that services will promote Mäori wellbeing in both health and social terms (Ratima 1998), and as a result will seek support and advice from quit coaches on a broad range of health and social issues.

• Quit coaches had strong ties with Mäori communities. This brought added credibility to the programme and allowed pilot providers to establish and maintain strong whänau links in order to support participants and to develop referral networks.

• The nature of quit coaching (counselling). The programme was delivered in a way that was acceptable and relevant to Mäori, including longer-term support of participants which contributed to both the acceptance of the programme for Mäori and the effectiveness of the programme to achieve a high quit rate.

10 The term described by Durie as ‘Nga Matatini Mäori, or Diverse Mäori realities’ recognises that ‘Mäori live in

diverse cultures. There is no one Mäori reality nor is there any longer a single definition which will encompass the range of Mäori lifestyles’.


Aukati Kai Paipa 2000 outcomes Success Indicator 1: The evaluation shows that the programme is effective in reducing smoking prevalence in Mäori women. Those not quit show a reduction in tobacco consumption. Success Indicator 2: The evaluation shows that the programme is effective in reducing smoking prevalence in whänau of Mäori women. Those not quit show a reduction in tobacco consumption. The programme was effective in reducing smoking rates for Mäori women and their whänau.

• The point prevalence quit rate at 12 months is 23% for all programme participants.

• The point prevalence quit rate at six months is 26% for all programme participants.

• The point prevalence quit rate for Mäori women participants only11 is 23% at 12 months and 26% at six months (conservative measure).12

• For comparison with other New Zealand smoking cessation programmes, a less conservative point prevalence quit rate13 gives a quit rate for all programme participants at 12 months of 30%, at six months of 32%. For Mäori women participants only the quit rate is 29% at 12 months.

• The quit rate for Aukati Kai Paipa 2000 is significantly higher than the latent quit rate.14 Using the less conservative measure for a valid comparison: – Aukati Kai Paipa 2000 quit rate for Mäori women participants over 12 months

was 29% – latent quit rate for Mäori women in the population over 12 months was 12.5%.

• Nicotine Replacement Therapy, especially when delivered at the optimal level of eight weeks (National Advisory Committee on Health and Disability 1999), enhanced quit rates. – Compared to 18% quit for non-users, those who used Nicotine Replacement

Therapy were more likely to quit (24% quit for all users, and 35% quit for those who used it for about eight weeks).

– Those who used 9 to 15 weeks of Nicotine Replacement Therapy (probably over two distinct quit attempts)15 were also more successful (27% quit) than non-users (18% quit). This suggests that for motivated quitters a second quit attempt in a 12-month period that is aided by Nicotine Replacement Therapy may be effective, at least for this type of programme.

11 Mäori women were a target for the programme and made up 66% of the participants. 12 Conservative measure (quit = not smoked for two days and have no occasional puffs and not quit = smoked in past

two days, or have occasional puffs, or not spoken to at follow-up). 13 Less conservative measure of the point prevalence quit rate – comparable to other New Zealand programmes (quit =

not smoked for two days and not quit = smoked in past two days, or not spoken to at follow-up). 14 The ‘latent quit rate’ is the quit rate that occurs in a population without a particular intervention programme. 15 According to anecdotal information from pilot providers.


– Both heavier and lighter smokers, and those more or less addicted to tobacco, were able to quit. These groups achieved similar quit rates.

The programme is effective in reducing tobacco consumption amongst Mäori women and their whänau. The tobacco intake and addiction levels of those who were not quit at 12 months decreased.

• At start day, over a third smoked 21–30 cigarettes per day (25%) or 31 or more cigarettes per day (11%). Of those not quit at 12 months, just 11% smoked over 20 cigarettes per day and half (51%) smoked 1 to 10 cigarettes per day.

The service was effective at increasing smokefree environments and benefiting participants and others they live with. At 12 months, both those who were quit and not quit had made positive smokefree changes.

• Half of those quit at 12 months reported that they had no current smokers in the household (51%, compared to 0% at start day).

• Nearly two-thirds of all participants (59% to 62%) reported their home, their car and their workplace was mostly auahi kore,16 or totally auahi kore at 12 months (around one-fifth – 16% to 23% reported this at start day).

• Half of those quit at 12 months who lived with children under 5 years old reported their home was totally auahi kore (51%), a further fifth said it was mostly auahi kore (18%).

• Those not quit also made changes – half of those who lived with children under 5 years old reported that their home was totally auahi kore (33%) or mostly auahi kore (22%).

Aukati Kai Paipa 2000 was an effective channel for providing counselling and Nicotine Replacement Therapy to Mäori women and their whänau. Mäori who accessed this programme, were not able to or did not wish to access other services. While on the programme, most (89%) used Nicotine Replacement Therapy. Few had used any Nicotine Replacement Therapy products in the past (19%). Success Indicator 3: The evaluation shows that the programme is acceptable to Mäori women. Aukati Kai Paipa 2000 was acceptable to Mäori, being both accessible and culturally appropriate for Mäori.

• Overall, the programme has been shown to deliver cessation services in a Mäori-appropriate, culturally-safe manner, considering the He Taura Tieke framework for measuring effective services for Mäori.17 A successful model has been developed to deliver Aukati Kai Paipa 2000 to Mäori women and their whänau.

16 Auahi kore (smokefree). 17 He Taura Tieke – Measuring Health Service Effectiveness for Mäori. Ministry of Health, Manatü Hauora (1995).


• Many barriers to access were removed, including financial barriers, being located in the community and by providing a familiar, welcoming environment.

• The programme has been accessed by a diverse range of Mäori women and their whänau. This includes a range of ages (especially over 30 years old), those who were unwaged, those with community services cards, people from larger households and who lived with other smokers, and longer-term/highly-addicted smokers.

• The programme was acceptable to Mäori women and their whänau. Mäori women and their whänau have taken part in the programme in large numbers (n=3200), with most pilot providers having to set up waiting lists.

It was more than I expected. We gave and received. It was such an awesome programme for Mäori women. We were made to feel a part of it. Aukati participant

Success Indicator 4: Aukati Kai Paipa 2000 was a relatively cost-effective18 means of reducing smoking prevalence among Mäori women. Full relative cost-effectiveness analysis is to be carried out by the Ministry of Health. The evaluation has collected cost data to inform this analysis. The cost of delivering Aukati Kai Paipa 2000 has been calculated by collecting and analysing data from one pilot provider.

• The cost per quitter is approximately $4310–$5715.19

• The cost per quitter/cut down to less than 10 cigarettes per day is approximately $2326–$2683.

It will be important in any decision-making about Aukati Kai Paipa 2000’s relative cost-effectiveness to consider that the programme has reached a ‘hard-to-reach’ group who tend not to access other services. It includes those for whom cost of health care is a barrier, those without telephone access, and those who prefer face-to-face services providing for varied cultural needs of Mäori. The medium- to long-term costs of not tackling smoking prevalence in this population and the medium- to long-term savings of working on this issue would far outweigh the costs of this programme.

18 Relative to alternative New Zealand smoking cessation interventions for Mäori women smokers. 19 The lower figure in this range uses the less conservative definition for ‘quit’.


Comparison with other smoking cessation programmes

• Quitline Subsidised NRT programme provides Nicotine Replacement Therapy, support and advice via the Quitline telephone service. The relative effectiveness of this programme compared to Aukati Kai Paipa 2000 cannot be determined until data on the characteristics of programme users and six-month and 12-month quit rates for Mäori on the Quitline programme are available in 2003.

• The Smokescreen programme is a mainstream cessation programme provided by GPs and hospitals (Woodward and Laugesen 2000) that provides Nicotine Replacement Therapy and counselling. At six months the Smokescreen programme achieved a point prevalence quit rate of 10% for those using primary health care services such as GP clinics rather than secondary services such as hospitals. (The Aukati Kai Paipa 2000 quit rate at six months is 32% using the comparable, less conservative measure.)

• The Noho Marae programme is a quit programme for Mäori provided in a Mäori setting. This programme requires participants to attend a five- to seven-day residential hui on a marae where they stop smoking on the first day of the hui. No Nicotine Replacement Therapy or other pharmacotherapies are used in the Noho Marae programme. At four months the Noho Marae programme achieved a 35% point prevalence quit rate (Glover 1999).

Conclusions

Is Aukati Kai Paipa 2000 effective in a Mäori setting (targeting Mäori women and their whänau)? The quit rate achieved by Aukati Kai Paipa 2000 is significantly higher than the quit rate recorded for Mäori women smokers in general. Furthermore, given the social-demographic characteristics and smoking/addiction profile of participants, the programme should be viewed as especially successful. The programme is effective.

• It has effective outcomes (high quit rates and decreases in tobacco consumption). Even those who are heavier smokers and those who are more highly addicted are able to quit on this programme.

• It is an effective channel for providing this intervention (Nicotine Replacement Therapy and counselling) to the target group (Mäori women and their whänau).

• It is acceptable to participants, accessible and culturally appropriate. Many barriers to access (eg, cost) have been removed, enabling a broad range of Mäori to use the service.

• It is also effective for non-Mäori smokers and male smokers (ie, whänau of Mäori women who participated in the programme).

• The demographic profile, the smoking/quitting history of the participants and the fact that participants do not tend to access other cessation services suggest that this programme is effective for people who may otherwise have difficulty quitting and who can be described as a ‘hard-to-reach’ group.


Is the programme relatively cost-effective? The cost-effectiveness of the programme in relation to alternative New Zealand cessation services has not been determined by this evaluation. Data has been collected to allow cost effectiveness analysis to be carried out by the Ministry of Health. It will be important in any decision-making about Aukati Kai Paipa 2000’s relative cost effectiveness to consider who the programme has reached and the lack of alternative services available to this group.

• This programme has been able to reach people who do not tend to access alternative smoking cessation services. Participants tended to be aware of, but few had accessed, Quitline for example.

• The demographic profile and smoking/quitting profile that characterises participants on this programme, together with international research, suggests that people who have accessed this programme are generally likely to have a low success in smoking cessation (ie, lower quit rates) compared to other smokers (Wakefield and Miller 1997; Osler and Prescot 1998).

The cost of the programme should be considered in context:

• Judgements about the relative cost of this programme need to consider the broader impacts of the programme. Specifically, in considering the full ‘cost’ of the programme, the impact of smoking prevalence and related health outcomes for Mäori ought to be considered (eg, escalation/alleviation of related illnesses of smokers and their whänau and overall health sector spending on smokers and their whänau).

• Therefore, the medium- to long-term costs of not tackling smoking prevalence in this population and the medium- to long-term savings of working on this issue, are both likely to far outweigh the costs of this programme.

Should the programme be expanded? The evaluation shows that Aukati Kai Paipa 2000 is effective for Mäori and is therefore a good candidate for a planned expansion.

On what basis should the programme be expanded? A number of issues need to be considered in regard to the programme expansion.

1. The availability of experienced Mäori providers. Providers ideally need an existing resource and client base to enable the programme to be implemented.

2. A programme of planned workforce development. There needs to be a triple focus – first on pilot providers who may wish to extend their contracts, secondly on existing Mäori health providers who may want to add Aukati Kai Paipa 2000 to their service-base, and thirdly developing new Mäori providers who may be established specifically to run Aukati Kai Paipa 2000.

3. Quality control through ongoing co-ordination and monitoring. Given the success of the whakawhänaungatanga approach in the pilot and the tuakana/teina concept used


in training new quit coaches, consideration should be given to pairing up experienced providers with novice providers.

4. Hapü Mäori women not accessing the programme in large numbers, even though they were an intended secondary target group. A different recruitment approach and formal protocols for support of hapü women may be needed. Furthermore, given the young age of hapü Mäori women, the decision to target hapü women with this type of cessation programme may need to be reconsidered.

5. An optimal level of support in terms of length of time using Nicotine Replacement Therapy.20 Give further consideration to having formal protocols to promote best practice in this area.

6. Maintenance of adequate, standardised monitoring of the programme in terms of participation rates and effectiveness (eg, quit rates).

7. A need for a governance structure to ensure that the many issues raised here are addressed in a uniform way. To be effective, this governance structure will need to be formalised by referring to it in provider service contracts or in a memorandum of understanding.

8. Adequate resourcing of the programme to ensure success. This would include resources for a team of three to four programme personnel with administration support, as well as resources that account for the fact that the programme is relatively intense, long term (probably), delivered in a variety of locations and needs to be adapted to meet the needs of the local Mäori community.

In addition to the considerations outlined above, we make the following recommendations about the extension of this pilot programme.

1. The programme be extended to include regions of high need (ie, high Mäori populations, and areas of high smoking prevalence). An extension would need to provide for the needs of Mäori providers.

2. The programme be provided in a holistic Mäori health service setting by a Mäori smokefree workforce.

3. Maintenance of diversity to ensure the success of an extension of the programme. (Purchase from diverse Mäori communities and encourage adaptation to fit with local settings.)

4. Intensive and long-term support of clients as a part of the service. (Regular, weekly contact initially for eight weeks, then irregular [fortnightly/monthly] contact for up to 12 months.)

5. Free Nicotine Replacement Therapy (for eight to 12 weeks) should be a part of the service.

20 Outcome data suggests that providing Nicotine Replacement Therapy for approximately 8 to 9 weeks is more likely

to correlate to a high quit rate compared to providing it for 16 or more weeks or for 3 to 4 weeks (or less).


6. Target certain groups of potential participants and use a different type of intervention with other potential participants (those who are younger, or who have not tried to stop smoking before).


1 An Introduction to the Aukati Kai Paipa 2000 Pilot Programme

1. An overview of Aukati Kai Paipa 2000, including: • the need for Aukati Kai Paipa 2000 • a free cessation programme for Mäori women • objectives and success indicators of the pilot programme • pilot providers • funding and size of Aukati Kai Paipa 2000 • the target population for the programme • the intervention • Nicotine Replacement Therapy • quit coaching (the counselling component) • training and co-ordination.

2. The Aukati Kai Paipa 2000 model (using the Stages of Change Model as a template). 3. The special nature of Aukati Kai Paipa 2000, the Mäori approach to smoking

cessation. 4. Context – a brief comment on some of the tobacco control activities occurring in

New Zealand at the time of the pilot programme, including other cessation programmes.

1.1 Overview of Aukati Kai Paipa 2000

1.1.1 The need for Aukati Kai Paipa 2000 The Aukati Kai Paipa 2000 pilot programme was developed to test the viability of implementing a proven smoking cessation intervention in a Mäori health setting. A number of factors contributed to the development of this pilot programme, including the following.

• In New Zealand, smoking prevalence is highest in the Mäori population compared to the non-Mäori population (Statistics New Zealand 1998; Ministry of Health 1999a),21 and particularly for Mäori youth and Mäori women.

• While, internationally, smoking cessation programmes have been shown to be particularly effective when they combine counselling with Nicotine Replacement Therapy (Ratima 1996),22 no cessation programme of this kind has ever been delivered specifically to Mäori by Mäori (Health Funding Authority 1998).

21 Of the New Zealand population (aged 15 or over), 12% of people identify as Mäori. In total, 44% of Mäori (aged

15 or over) smoke, while 24% of the total New Zealand population (aged 15 or over) smokes. 22 The American guidelines for smoking cessation encourage the use of Nicotine Replacement Therapy and recommend

that this be followed with regular support sessions with participants (ie, counselling).


• Reducing the impact of tobacco consumption on health is a high priority for the current (and the previous) New Zealand Government. As such, the pilot programme was developed as ‘part of the Health Funding Authority’s strategy to reduce the prevalence of tobacco consumption and to improve the overall health of Mäori, and will support Mäori provider development to enable consolidation and continuation of quality Mäori service providers and Mäori personnel within the sector’ (Health Funding Authority 1998).

• Reducing smoking prevalence amongst Mäori will contribute to reducing inequalities (Ministry of Health 1999a)23 in the health status of Mäori compared to non-Mäori.

1.1.2 A free cessation programme for Mäori women Aukati Kai Paipa 2000 was a smoking cessation programme primarily for Mäori women,24 and involved the provision of Nicotine Replacement Therapy together with counselling delivered by quit coaches. The programme was free of charge to all participants regardless of whether they participated in the evaluation of the programme.

1.1.3 Objectives and success indicators for the pilot programme The overarching objective of Aukati Kai Paipa 2000 was to confirm that a smoking cessation intervention that utilised a combined Nicotine Replacement Therapy and counselling approach in a Mäori setting would be effective25 for Mäori and, in particular, for Mäori women and their whänau. The objectives of Aukati Kai Paipa 2000 were therefore:

1. to determine whether the intervention was ‘effective’ (see Footnote 25, below) in a Mäori setting (targeting Mäori women and their whänau)

2. to inform decisions about possibly expanding the programme following the pilot period

3. if expansion was indicated, to identify on what basis such an expansion should be undertaken.

23 Each year, 21% of deaths of Mäori females (aged 15 or over) are from smoking-related causes (based on 1996

mortality and prevalence rates). 24 The target population for the programme is motivated Mäori women (particularly those who are hapü), and their

whänau, all of whom are aged 18 years or over. Mäori women were targeted because of their high smoking prevalence.

25 In addition to decreasing smoking prevalence and tobacco consumption, a key aspect of confirming the effectiveness of the intervention for Mäori was to determine whether the intervention would be acceptable (ie, accessible, culturally appropriate, etc) to Mäori women and their whänau. See Section 5.4 for further explanation.


Given the objectives of Aukati Kai Paipa 2000, four success indicators were agreed for the programme following consultation with key stakeholders.

1. A reduction in smoking prevalence for Mäori women on the programme achieved and maintained for three, six, and 12 months after enrolment as compared to Mäori women smokers not on the programme.26 Secondarily, for those not quit at 12 months, a reduction in tobacco consumption over the 12-month period.

2. A reduction in smoking prevalence for whänau of Mäori women on the programme achieved and maintained three, six, and 12 months after enrolment. (That is a reduction similar to Mäori women participating on the programme.) Secondarily, for those not quit at 12 months, a reduction in tobacco consumption over the 12-month period.

3. That Aukati Kai Paipa 2000 was acceptable to Mäori women participating in the programme. (That is, perceived as acceptable by participants, shown to be accessible to Mäori women and their whänau, and shown to be culturally appropriate [Osler and Prescot 1998].)27

4. That Aukati Kai Paipa 2000 was a relatively cost-effective28 means of reducing smoking prevalence among Mäori women.

1.1.4 Pilot providers The programme was piloted in a variety of locations and situations. Seven Mäori health providers delivered the service in separate locations around New Zealand.29 Those chosen to deliver the pilot programme were representative of the wide variety of Mäori health providers in New Zealand. Each pilot provider adapted the programme to fit the local situation. See Section 3.3 for further details.

1.1.5 Funding and size of Aukati Kai Paipa 2000 Funding for the pilot programme was made available so that the pilot could be delivered by the seven Mäori health providers for two years, from mid-1999 to the end of June 2001. See Section 3.2 for further details. During the life of the pilot, the aim was to recruit between 2000 and 3500 participants.

26 A telephone survey of Mäori women smokers not on Aukati Kai Paipa 2000 (baseline survey) was carried out as a

part of the evaluation. This determined the ‘latent quit rate’ for Mäori women smokers over a 12-month period as a comparison to the quit rate of Mäori women smokers on the programme. A significantly higher quit rate among Mäori women on the programme compared to the latent quit rate would indicate success. See Appendix E for full description of the baseline survey.


28 Relative to alternative New Zealand smoking cessation interventions for Mäori women smokers. See Section 5.5 for a further explanation of relative cost-effectiveness (including calculation of cost per quitter).

29 The locations include very small, isolated towns to the largest city in New Zealand. Some locations had a high density of Mäori (around 50%) while in other locations Mäori made up only a small proportion of the population (less than 10%).


1.1.6 The target population for the programme The target population for the pilot programme was motivated30 Mäori women,31 (particularly those who were hapü),32 and their whänau. This meant that while Mäori women were targeted, their whänau living in their household were also encouraged to participate in the programme. This aspect aimed to assist participants to form a supportive network around them of non-smokers or fellow quitters. Additionally, all participants were to be aged 18 years or over.

1.1.7 The intervention At the outset of the pilot programme the intention was to provide a maximum of eight weeks’ Nicotine Replacement Therapy in the form of gum and/or patches, together with counselling delivered by quit coaches. More specifically, the intervention was to take one of the following forms:

• Nicotine Replacement Therapy (up to eight weeks) and one counselling session (to discuss the use of Nicotine Replacement Therapy).

• Nicotine Replacement Therapy with the recommended level of counselling (four or more sessions).

• Counselling alone (eg, for women who are hapü and who choose not to use Nicotine Replacement Therapy).

While the intervention can be described broadly in the above terms, in reality the interventions delivered by different pilot providers were diverse and tended to last for far longer than the period during which the Nicotine Replacement Therapy was used. While Nicotine Replacement Therapy tended to be provided for a four- to eight-week period, weekly contact (or even more frequent contact) with participants continued for between four and 12 weeks, followed by monthly contact for six to eight months or more. Some individual participants received more than eight weeks of Nicotine Replacement Therapy.33 See Section 1.3 for commentary on the special nature of the programme.

30 During an assessment session with their quit coach, potential participants were assessed as to their level of

motivation to quit smoking, using the Stages of Change Model (with stages ‘Pre-contemplation’, ‘Contemplation’, ‘Action’, etc). Only those in the contemplation stage or a later stage were permitted onto the programme (Prochaska and DiClemante 1982).

31 Mäori women were a target for the programme and made up 66% of the participants. 32 Manufacturers of Nicotine Replacement Therapy do not recommend the use of Nicotine Replacement Therapy during

pregnancy (Ministry of Health 1999), nor is its use a contra-indication (Wilson 1998). Mäori women who were hapü wishing to participate in the programme had the choice of using Nicotine Replacement Therapy (with the approval of their medical practitioner) or, alternatively, accessing only the quit coaching (counselling) service. There was limited uptake of the offer of free Nicotine Replacement Therapy among Mäori women who were hapü.

33 The programme was adjusted to meet the needs of individual participants. Some very addicted participants received up to 12 weeks of Nicotine Replacement Therapy at one time. Others received more than eight weeks of Nicotine Replacement Therapy because it was spread across two discreet quitting attempts (some months apart).


1.1.8 Nicotine Replacement Therapy The Nicotine Replacement Therapy used by the pilot providers was the Novartis products: Nicotinel patches (sizes 7 mg, 14 mg, and 21 mg) which adhere to the skin, and Nicotinel gum (2 mg and 4 mg).

1.1.9 Quit coaching (counselling component) Mäori quit coaches provided support in person (or, at times, by telephone) within the participants’ local communities. The quit coach role was extensive and very much tailored to the needs of local participants. See Section 1.3.5 for further details.

1.1.10 Training and co-ordination A training and co-ordination component was purchased from a Mäori Training Provider (Te Hotu Mänawa Mäori) to run in parallel with the programme delivery. Prior to commencing recruitment of participants, all quit coaches received training. The purpose of the trainer/co-ordinator role was to maximise the quality of the pilot programme and to ensure consistency in the delivery of the interventions. See Section 3.4 for further details.

1.2 The Aukati Kai Paipa 2000 model

1.2.1 Stages of Change Model The delivery of the Aukati Kai Paipa 2000 pilot programme is modelled on the stages of the quit cycle itself. The Stages of Change Model (Prochaska and DiClemante 1982) describes the cognitive and behavioural change that occurs in a person quitting an addiction such as smoking. • ‘Pre-contemplation’ stage (not thinking about quitting). • ‘Contemplation’ stage (thinking about quitting but not within the next 30 days). • ‘Action’ stage (preparing to quit, taking action towards quitting, quitting smoking). • ‘Maintenance’/‘Relapse’ stages (period after quitting when relapse is likely or has

happened).


Figure 1: The Stages of Change Model

Smoking/Kai Paipa

CommunityMe Mutu/Quit

Pre-contemplation

Contemplation

Relapse

Action

Maintenance The QuittingCycle

1.2.2 The Aukati Kai Paipa 2000 model The delivery of the Aukati Kai Paipa 2000 pilot programme itself can be described as comprising a series of stages. Several intervention stages of the programme parallel those in the Stages of Change Model described in the previous section:

• Networking and planning referral systems (interaction with local health and social services).

• Recruitment and programme promotion.

• ‘Preparation-work’ with participants (up to three weeks of education, planning to quit, practising ‘cold turkey’). (Equivalent to ‘pre-contemplation’ stage.)

• Assessment of motivation to quit (an interview to assess motivation to quit, and suitability to go on to the programme a day or two before quit day).34

• Intensive programme (coaching and Nicotine Replacement Therapy from quit day to two to six weeks dependent on smoking rate/addiction, and length of withdrawal period). (Equivalent to ‘Action’ stage.)

• Maintenance and relapse prevention (from three to six weeks after quit day to three months to six months after quit day). (Equivalent to ‘Maintenance’ stage.)

• Dealing with relapse (timeframe is flexible and occurs only if participant relapses to smoking). (Equivalent to ‘Relapse’ stage.)

See Appendix B for a detailed chart describing the key activities and key tasks of each stage of the programme delivery.

34 Only those assessed as ‘Ready to quit’ (ie, in late ‘Contemplation phase’ or ‘Action phase’ on the Stages of Change

Model were suitable to go on to the programme).


Figure 2: Stage model of Aukati Kai Paipa 2000

NetworkingSmoking

CommunityAuahi Kore

Preparation workwith clients

Dealing withrelapse

Intenseprogramme

(NRT and QC)

Maintenanceand relapseprevention

AukatiKai Paipa

Assessment

Recruitment/promotion

1.3 The special nature of Aukati Kai Paipa 2000 – the Mäori approach to smoking cessation

In this section a number of features of Aukati Kai Paipa 2000 are described that have enhanced the acceptability of the programme for Mäori: • The Mäori setting for the programme delivery. • Diversity in delivery of the programme. • Delivery within a holistic health service setting. • Quit coaches’ strong ties with Mäori communities. • The nature of quit coaching (counselling). • Whakawhänaungatanga (building relationships) between pilot providers.

1.3.1 The pilot programme operated in a Mäori setting The pilot programme operated in a Mäori setting, meaning that it was delivered to Mäori by Mäori usually in a Mäori venue. These settings generate the cultural richness and responsiveness of the pilot programme. All those delivering the pilot programme were Mäori, and lived and worked in the communities to whom they were delivering. Mäori are best able to work with Mäori clients in a truly empathetic way. As Mäori, the quit coaches possessed a knowledge and sensitivity to Mäori needs. They were able to discuss issues from a Mäori perspective, and easily developed a rapport and trust with clients. This allowed the service to be consistent with Mäori culture and values. In this environment the service was delivered with an understanding of tikanga and an acknowledgement of Mäoritanga achieved through karakia, waiata, te reo and manaakitanga.


Operating in a Mäori setting places additional tensions on Mäori health service providers, but also adds to the cultural richness and cultural responsiveness of the service they deliver.

• The workforce available to deliver a service is small and management experience in a clinical and administrative sense is less mature.

• Mäori settings tend to be community-based and subject to community and cultural influences. Many Mäori have a different set of expectations from other consumers. For example, many Mäori consumers do not distinguish between health and other social services in a Mäori setting, and cultural protocols will often take precedence over health sector protocols. See Section 1.3.3 for further commentary (Durie et al 1995).

• Even though the funders recognise the advantage of operating in a Mäori setting, the additional expectations of clients have to be met within the budget of the narrower Aukati Kai Paipa 2000 pilot programme.

1.3.2 Diversity in delivery The nature of the Aukati Kai Paipa 2000 pilot programme, in its finer details, differed with each pilot provider. Each pilot provider adapted the programme to cater for the needs and expectations of their local Mäori community (eg, including whether to provide one-on-one and/or group sessions; whether to deliver the service at a clinic or at a wide number of locations such as local marae/education centre/workplace) and, to an extent, to manage the programme within the resources available to the provider. The location of the health providers and the varied method of service delivery provided at each pilot provider reflected the social and cultural diversity of Mäori (Durie 1994).35 For example, some of the health providers were marae-based while others were based within health clinics in cities. The benefit of this was that the programme was able to reach diverse Mäori communities.

1.3.3 A holistic health service setting Health providers delivering the pilot programme were based within a holistic health and social service setting and clearly articulated this philosophy. Naturally, Mäori consumers of services tend not to distinguish between health and other social services when the service is provided by a Mäori health provider. The holistic, asectoral view of health, based on the Mäori worldview of connectedness and interdependence (Cunningham 1998), means that the obligations inherent on the provider by the clients is more than typically reflected in ‘health service’ contracts. Mäori clients will expect that the service promotes Mäori wellbeing in both health and social terms (Ratima 1998), and as a result will seek support and advice from quit coaches on a broad range of health and social issues. Characteristic of a Mäori health service is the integration of the service with other community (and/or tribal) programmes (Durie 1995). It is this 35 The term described by Durie as ‘Nga Matatini Mäori, or Diverse Mäori realities’ recognises that ‘Mäori live in

diverse culture. There is no one Mäori reality nor is there any longer a single definition which will encompass the range of Mäori lifestyles’.


environment, which is perceived as culturally safe, that makes the service and the programme more acceptable to Mäori. In order to respond and meet participants’ expectations, pilot providers developed networks with other health and social services to ensure that they could refer their clients to all the services they needed. The complementary services offered by the providers were key to the pilot programme’s success and meant that the pilot programme was a gateway into other health and social services for many Mäori women on the programme. It must be recognised that this broader approach to provision is largely unresourced and falls as a cost to the pilot provider or the organisation to which the provider belongs.

1.3.4 Strong ties with Mäori communities The quit coaches were well known, active participants in their communities (they participated in, and supported, numerous community activities; eg, Kaumatua Ball Fundraiser, Trivial Pursuit events, children’s day, whänau day, Marae Expo, waka ama teams, kapa haka groups, coaching/sponsoring sports teams).36 All quit coaches were confirmed non-smokers and many were ex-smokers. Whilst a few quit coaches had previous cessation experience with Act Now or Noho Marae, most did not. Most quit coaches were female, some were registered or enrolled nurses,37 and many were combining quit coaching with other health or social services roles (eg, asthma educators, whänau support, budget advice, cervical/breast screening). Others had a counselling or education background. The quit coaches were therefore a heterogeneous group, some of whom were lay practitioners of some experience and expertise, and might best be described as Mäori community/health workers. Quit coaches’ participation in their communities strengthened the pilot providers’ links with the community and added to the credibility of the programme. Participants were familiar with quit coaches, making quit coaches and the programme more readily acceptable. Having a strong connection with their community allowed pilot providers to establish and maintain strong whänau links in order to support participants and to provide appropriate referral networks (for referrals to/from local health and social services).

1.3.5 The nature of quit coaching (counselling) The counselling component of the pilot programme was delivered by quit coaches. Prior to commencing recruitment of participants, all quit coaches received training delivered by a Mäori Training Provider (Te Hotu Manawa Mäori).

36 For example, they supported sports teams with Smokefree brand water bottles. 37 That is, four of the 20 for which there was detailed information were registered or enrolled nurses.


The programme was delivered in a way that was acceptable and relevant to Mäori. Quit coaches travelled short distances38 to meet with groups of participants in their homes, school halls, at their workplaces or on marae, providing intensive support either face-to-face, in groups, or individually to their clients. Quit coaching focused on encouraging participants to socialise with other quitters for support, as well as providing tips to motivate participants to quit and stay quit, and how to keep busy during cravings. Quit coaches used numerous Mäori-language or Mäori-relevant resources such as whakataukii, poems and stories, factsheets on smoking and quitting, fridge magnets and stickers, as well as exercise sessions, health education, nutrition tips and Mäori handcraft. Through the obligations of manaakitanga, the support and contact with participants tended to last far longer than initially planned (six months or more, rather than eight weeks). Whilst allowing the pilot provider to meet their obligations, this longer-term support of participants has probably been a key factor in contributing to both the acceptance of the pilot programme for Mäori and the effectiveness of the programme to achieve a high quit rate for Mäori women and their whänau. Also see Stories from Whänau (Section 5.1: vignettes of those who participated in the pilot programme.

1.3.6 Whakawhänaungatanga (building relationships) between pilot providers

The regular hui of all key stakeholders was a key success of the pilot programme.

• The regular communication between key stakeholders (all seven pilot providers, the trainer/co-ordinator, the key HFA contact, and the evaluators), principally at hui, was an invaluable forum for the development of the pilot programme.

• The physical distance between pilot providers (together with heavy workloads) meant that there was little opportunity for face-to-face contact among the providers other than hui.

• The hui were about sharing, and whakawhänaungatanga. These hui allowed a collaborative approach whereby all key stakeholders discussed the barriers to progress and identified appropriate solutions. Thus the pilot programme evolved to include protocols and processes that were both Mäori appropriate and that met the health sector standards which were agreed with and understood by all parties.

• Furthermore, these hui gave pilot providers culturally appropriate support during a time when they experienced ongoing stresses related to developing and running the new programme. This was especially important for those teams with limited experience in delivering personal health programmes.

38 This tended to be one hour by car at most.


• During these hui, pilot providers came to know each other well enough to help and support each other. For example, they shared Nicotine Replacement Therapy products when the supply was disrupted. Also see Section 4.6 for more commentary on this issue.

1.4 Tobacco control context in New Zealand during the pilot period

When Aukati Kai Paipa 2000 was running as a pilot from mid-1999 to mid-2001, the Government spent approximately $17 million on tobacco control. This included health education, the smokefree schools programme, Smokefree sponsorship of sporting and cultural events (via the Health Sponsorship Council), enforcement of the Smoke-free Environments Act 1990 and a number of smoking cessation initiatives. The latter included Aukati Kai Paipa 2000, and other regional smoking cessation programmes as well as Quit Group activities (including the Quitline and the Quit Media campaign amongst others). From March 1999 the Quitline delivered a national, telephone-based counselling only service (ie, it did not include the provision of Nicotine Replacement Therapy. It had previously been piloted for six months in the Bay of Plenty region). From November 2000 the Quitline service expanded to incorporate the Subsidised NRT Programme. Other activities including some smoking cessation programmes also occurred, although these were supported by research grants or similar rather than the Ministry of Health. See Section 6.4 for discussion on the possible impact of these activities on the outcomes of the Aukati Kai Paipa 2000.


2 The Evaluation Methodology

2.1 Evaluation objectives Internationally, the combined delivery of Nicotine Replacement Therapy and counselling is considered to be an effective intervention to aid smokers to quit smoking. The effectiveness of such an intervention is therefore not in question. The value of carrying out this pilot was to evaluate the intervention’s effectiveness and relative cost-effectiveness, its acceptability to Mäori, and in doing so to learn how best to deliver such an intervention within a Mäori setting. The key objectives of the evaluation were therefore:

1. To confirm39 that Aukati Kai Paipa 2000 is effective in reducing smoking prevalence and (secondarily) in reducing tobacco consumption among Mäori women smokers and whänau on the programme. That is, achieve a quit rate significantly higher than the latent quit rate as measured by the baseline survey.40

2. To determine whether Aukati Kai Paipa 2000 was an effective channel for delivering Nicotine Replacement Therapy and counselling to Mäori women smokers and their whänau. That is, participants were easily able to access the programme and utilised the Nicotine Replacement Therapy and counselling.

3. To assess the acceptability of Aukati Kai Paipa 2000 as a programme that utilised a combined Nicotine Replacement Therapy and counselling approach in a Mäori setting. That is, to determine whether it was perceived as acceptable by participants, was accessible, and was culturally appropriate.41

4. To collect data to inform an analysis of the relative cost-effectiveness42 of the Aukati Kai Paipa 2000 programme. To present an estimate of the cost per quitter on Aukati Kai Paipa 2000.

An additional objective of the evaluation was to identify the typical barriers to the delivery of the programme in a Mäori setting, identify critical success factors of an effective programme, and to describe the ideal provider. In addition to data on effectiveness and acceptability of the programme, this information would further inform decisions about possible expansion of the programme following the pilot period.

39 Given that internationally this intervention (counselling and Nicotine Replacement Therapy) is a known effective

intervention, the focus of the evaluation was to confirm that intervention could reduce smoking prevalence for Mäori women smokers and their whänau.

40 A telephone survey of Mäori women smokers not on Aukati Kai Paipa 2000 was carried out as a part of the evaluation (baseline survey). This determined the ‘latent quit rate’ for Mäori women smokers over a 12-month period as a comparison to the quit rate of Mäori women smokers on the programme. A significantly higher quit rate among Mäori women and their whänau on the programme compared to the latent quit rate would indicate success.


42 Relative to alternative smoking cessation interventions in New Zealand.


2.2 The evaluation approach The evaluation was designed and delivered using a Mäori-focused approach. The evaluation had process evaluation components (including formative feedback to pilot providers) in which the programme delivery was fully described and outcome evaluation components, in which the programme outcomes were measured (quit rate, reduction in tobacco consumption and cost per quitter). See Appendix A for a full description of the evaluation methodology. The following table (Table 1) shows the specific evaluation activities completed in relation to each evaluation objective. Table 1: Evaluation methodology – a summary of the evaluation objectives and activities

Evaluation objective Areas of examination Evaluation activity

Consultation: To finalise key evaluation objectives, meet with stakeholders, and develop and maintain contact with all stakeholders throughout the evaluation.

• Consult with HFA and PHARMAC to finalise the objectives and outputs of the evaluation, and discuss methodology and timeframes.

• Collect and review programme documentation.

• Consult with other stakeholder groups (plan for ongoing consultation and contact throughout the pilot, via formal methods such as interim reports and brief update reports, and informal methods, such as regular meetings and communications).

Key informant interviews with HFA and PHARMAC representatives, the trainer, providers’ staff, representatives of organisations who would be interested in the outcome of the programme (Ministry of Health, Health Sponsorship Council, Quitline).

Documentation:

• Pilot framework, Registrations of Interest (ROIs), Requests For Proposal (RFPs), trainer and provider service descriptions (prepared by HFA and/or providers).

• The Assessment Tool to be used by providers, training modules, and other training documentation (designed by the trainer).



Outcome evaluation:

Formative objective: To assist pilot providers to set up good quality data collection systems.

Outcome objective: Show evidence for or against the acceptability and effectiveness of this smoking cessation programme for Mäori women.

Formative evaluation:

• Design data collection processes.

• Consult with pilot providers about data collection, finalise data collection forms and database.

• Train provider staff on data collection processes.

• Assist providers in data collection (help documents, technical IT advice, audit the quality data and give feedback, audit enrolments to establish whether motivated quitters are enrolled).

Outcome evaluation:

• Finalise a definition for ‘quit’ and the ‘quit rate’.

• Collect and report on the outcomes at each provider site (uptake by Mäori women and whänau, effective delivery of Nicotine Replacement Therapy, whether the programme is acceptable/appropriate, quit rates).

Formative activities:

• Design, consult on and finalise data collection tools and processes.

• Ongoing support, training and audits on the data collection process (including extensive IT telephone support and some site visits by IT staff to ensure data recording occurred).

Outcome activities:

• Survey of all participants at four points: – Assessment interview (start day). – At 3 months. – At 6 months. – At 12 months.

• Recording of contacts and prescriptions data for all participants: – Number and type of contacts

with quit coaches. – Type and amount of Nicotine

Replacement Therapy prescribed.

• Interview quit coaches and managers, survey quit coaches, attend regional and national hui to collect information on acceptability and appropriateness.



Cross-site evaluation: To describe the pilot providers and any problems encountered in delivering the service.

A site-by-site description of the providers on the programme including:

• A descriptive profile of each pilot provider. Describe governance, type and number of other service contracts, the staffing structure, the community clients are drawn from, linkages with the local community and other providers in the community.

• A description of the programme at each site. Describing participant recruitment, promotions, and interventions used with participants including other services participants typically referred to, and the length of time participants were involved in the programme. Data on participant enrolment and drop-out rates, reasons for drop-outs, staff experience, staff training, staff turnover, any compliments or complaints, etc.

• Identify main costs of the programme delivery – staff numbers (paid and unpaid), office space rental, transportation, telecommunications and participant recruitment costs, etc.

• Record details of providers’ activities that relate to keys to success or barriers delivering the programme.

• Two site visits to each pilot provider.

• Key informant interviews with co-ordinators/managers and quit coaches, Chief Executive Officers (CEOs)/Directors.

• View documentation, examine programme databases, interview key informants.

• Quit coach survey.

• Exit interviews with co-ordinators/ managers and quit coaches (if they left employment).



Detailed evaluation of one pilot provider: Part 1: To describe in detail the processes and areas for improvement to the staff recruitment, staff training, management systems, participant recruitment and assessment, participant counselling.

This detailed evaluation therefore covered six phases:

• The provider staff recruitment. Collect details on the recruitment process and quit coaches’ opinions about recruitment and expectations of their role.

• The provider staff training phase. Collect information on quit coaches’ opinions about the training and ongoing support by the trainer.

• Providing management support to provider staff. Review systems to support staff, what processes are in place and how this is maintained. Collect information on quit coaches’ satisfaction with this ongoing support.

• The participant recruitment phase. Examine the participant recruitment process, including enrolment. Monitor participants’ opinions directly to determine how to improve the service delivery in regard to recruitment.

• The participant assessment phase. Review the participant assessment.

• The participant counselling phase. Monitor participants’ opinions to determine how to improve the service delivery for counselling.

Key activities included:

• Site visits (three in total) with observation and interviews with staff.

• Examine staff recruitment documentation.

• Examine systems in place to manage delivery of the programme.

• Additional questions in the quit coach survey covering the quit coaches’ opinions about their own recruitment and staff management issues.

• Interviews by Mäori evaluators directly with participants at three points in their service delivery (recruitment interviews, mid-trial interviews, and exit interviews).

Detailed evaluation of one pilot provider: Part 2: To calculate the cost of delivering the programme, and in particular the cost per quitter

• Collect documentation from the Health Funding Authority about the basis on which the programme is funded.

• Collect and examine the financial operating statements prepared by the provider to identify: – income available to support the

programme – costs (direct and indirect) related

to establishment versus ongoing operation of the programme eliminating any costs specific to the evaluation, if any.

• Collect information on the overhead costs relating to the work of each quit coach at the location they work, such as use of office space, reception resources, telecommunications and transport.

• Collect description of hidden costs of delivering this programme through interviews, and diaries for quit coaches.

• Collect relevant documentation from Health Funding Authority, interview key informant to clarify details.

• Confirm pilot provider is recording detailed financial records. Collect from pilot provider.

• Interview manager to determine which phase of activity costs relate to (establishment).

• Diaries of quit coaches for two weeks to understand use of facilities at other locations.

• Analysis of participant-related data (referred to in ‘outcome evaluation’ section).



Evaluation of training role:

To develop a working relationship with key trainer staff.

To carry out a process evaluation of the trainers’ activities.

• Establish regular contact with the trainer staff, including regular telephone and email contact.

• Collect details of the training activities and review training activities against trainer ROI.

• Collect information on quit coaches’ and managers’ perceptions of the training and co-ordination role.

• Collect information on the trainers’ systems for monitoring pilot providers’ staff needs for ongoing support.

• Collect all training documentation (modules and materials), trainer ROI and trainer proposals.

• Interview key trainer staff.

• Participate in all regional and national hui with pilot providers and the trainers.

• Design and carry out a survey of all quit coaches (anonymous, self-completion, mail-back survey), on quit coaches’ opinions about the training and ongoing support provided by the trainers.

• Interview the provider staff (quit coaches and manager) about the ongoing support provided by the trainer.

Baseline survey (latent quit rate measure): To determine the latent quit rate over 12 months of Mäori women not on the programme.

• A screening survey of Mäori women to identify smoking status; non-smokers, those currently quit (quit in past 12 months), those wanting to quit, current smokers, etc.

• A full survey of currently quit and those wanting to quit to collect a demographic and environmental profile and smoking/quitting profile of respondents.

• A screening survey by telephone to identify respondents.

• A full telephone survey of those currently quit and wanting to quit.

2.2.1 The evaluation team The evaluation team contracted to evaluate Aukati Kai Paipa 2000 was a joint venture between Te Pümanawa Hauora – a Mäori Health Research Unit within the School of Mäori Studies at Massey University, Palmerston North – and BRC Marketing & Social Research – a Wellington-based mainstream research company specialising in market research/social research in the private and public sectors and in programme evaluation.

2.2.2 Information sources for the evaluation During the pilot programme, extensive data was collected to record who participated in the programme, how the programme was adapted for local needs, and to determine success of the programme in terms of reduction in smoking prevalence, acceptability to Mäori, etc. Key sources of information included:

• participants (interviews by quit coaches and evaluators)

• quit coaches and managers/co-ordinators (site visits, surveys about quit coach training, interviews by evaluators, discussions at hui)

• trainers/co-ordinators (interviews by evaluators, attendance at training hui, discussions at hui)

• senior management/governance personnel of pilot providers (interviews by evaluators)


• consultation with other stakeholders – Ministry of Health/Health Funding Authority, PHARMAC, Novartis, etc (interviews by evaluators)

• Ministry of Health/Health Funding Authority documentation (including the programme purchasing plan, provider service specifications, etc)

• relevant smoking cessation and smokefree information (from health publications, scientific literature, and attendance at international and New Zealand conferences).

See Appendix A for details of the evaluation, including key audiences for the evaluation, difficulties encountered in collecting the evaluation information, etc.

2.3 Strengths and limitations of the evaluation Every project, such as an evaluation, has limited resources. At many points in the process of designing and carrying out an evaluation decisions must be made to forego more robust or more detailed data in one area to afford the opportunity to collect information in another area. As a result there are always areas where more or better information could have been collected either through better design or better implementation. In this section we describe the strengths and limitations of the evaluation. See Appendix A, Sections 8 and 9 for further discussion on this and related issues (such as data validity and reliability).

• Overall, the evaluation was a success in that most information and data was collected as planned. All the main information needs of the evaluation were met (see Section 2.1 above for a description of the four evaluation objectives).

• The quit rate measure is strong, but probably underestimates the true proportion of participants quit at six months and at 12 months for the following reasons:

– Participants could not be contacted at follow-up were denoted as ‘not quit’ for the quit rate measure. See Appendix A, Section 6 for a full explanation.

– Quit coaches discussed participants’ smoking behaviour/quit status with them at every contact they had (from start day of the programme), thus developing an open and honest therapeutic relationship in which ‘slip-ups’ or full relapses were discussed and dealt with (sometimes recommencing Nicotine Replacement Therapy if it was considered to be appropriate). Thus, participants were likely to be motivated to be honest about any smoking rather than to hide it.

– Quit coaches tended to be closely involved in the community and were usually fully aware of whether participants were smoking or not prior to asking them directly. Thus, quit coaches could be said to have provided verification of the self-reported quit status.

– Although data was collected and recorded by quit coaches, it was audited regularly by the evaluation team. Audits indicated that although there was some missing data, the information that was recorded in the databases had a high level of accuracy. See Appendix A, Section 8 for a full explanation.


There are two main limitations in terms of the data collected in the evaluation. (See Appendix A for a full commentary.)

• Due to the need for early data on quit rate, measurements were commenced as soon as the programme started, rather than the ideal of waiting for the new programme to ‘settle’.

• Although the quit rate measure is strong, a self-reported quit status measure (ie, it was not verified) was used, for the following reasons:

– Due to the extraordinary expense required (as well as cultural considerations), the self-reported quit status of participants has not been independently verified using standard tests (such as a saliva tests or carbon monoxide breathalyser).

– All data collected from participants was collected and electronically recorded by pilot providers. Some pilot providers missed collecting some data. See Appendix C for full commentary on the approach taken to missing data.

The quit rate measure used a ‘point prevalence’ quit rate which allowed comparisons with similar Australasian smoking cessation programmes. However, some studies internationally collect ‘continuous quit rate’. See Appendix A for full commentary.


3 The Establishment and Implementation of Aukati Kai Paipa 2000

This section of the report outlines key aspects of the establishment and implementation of the Aukati Kai Paipa 2000 programme:

• The design of Aukati Kai Paipa 2000 by the steering group and advisory group of experts.

• The funding of the pilot programme.

• The Mäori health providers that delivered Aukati Kai Paipa 2000.

• The training/co-ordination role.

• Key aspects of the evaluation. See the earlier process-focused evaluation report for more details of the establishment and implementation of Aukati Kai Paipa 2000 (BRC Marketing & Social Research and Te Pümanawa Hauora 2000).

3.1 The HFA/PHARMAC Steering Group and the Advisory Group

An HFA/PHARMAC Steering Group for Aukati Kai Paipa 2000 conceptualised the pilot programme. To ensure the pilot programme would be appropriate for Mäori, an Advisory Group of Mäori, Public Health, Auahi Kore (Smokefree) and smoking cessation experts was formed (Health Funding Authority 1998).43 During the 1998/1999 financial year the Advisory Group advised the HFA/PHARMAC Steering Group about the ideal design of the pilot programme. On the recommendations of the Advisory Group, the Steering Group purchased the pilot programme, the pharmaceutical service (supply of Nicotine Replacement Therapy), the training and co-ordination component, and the evaluation of the pilot programme. See the earlier process-focused evaluation report (BRC Marketing & Social Research and Te Pümanawa Hauora 2001) and the Purchasing Framework (Health Funding Authority 1998) for more details.

43 This group included Marewa Glover, Eri Hauwai, and Yvonne Stirling-Mohi, members of Aparangi Tautoko Auahi

Kore (ATAK), Joe Puketapu and Carolyn Tikiku from Te Hotu Manawa Mäori, Tane Cassidy from Te Puni Kökiri and Mary McCulloch (HFA). Assistance with the spatial analysis was provided by Dr Nicholas Wilson.


3.2 Funding the pilot programme Pilot providers were funded to deliver the pilot programme for a two-year period. The funding for Aukati Kai Paipa 2000 had three components:44

• Funding for operational and administration costs of Aukati Kai Paipa 2000 (per annum).

• Funding on a pro rata basis for participants recruited on to the programme ($50.00 per participant up to a maximum number per annum).

• Separate funding for the purchasing of Nicotine Replacement Therapy (to a maximum amount per annum).

The bulk purchase of all Nicotine Replacement Therapy for the pilot programme was handled by the Health Funding Authority. Pilot providers simply ordered appropriate amounts of the pre-purchased product from the supplier, as needed. In addition, all pilot providers were funded with a core budget shared across all health contracts (typically 10 to 12 distinct contracts or more). The core budget was to cover overheads, including office space (building rental/purchase and maintenance), utilities (electricity, water, etc), office furniture and equipment (photocopiers, computers, desks, filing cabinets, etc), telecommunications (landlines for local calls, not tolls, cell phone calls, or cell phone purchase or rental), receptionist and reception resources, and some aspects of personnel training.

3.3 The providers Seven pilot providers (the two Northland providers were initially a joint venture) were selected to provide Aukati Kai Paipa 2000. Two of the pilot providers also sub-contracted to individuals or other health providers to deliver the service (Ngäti Whatua O Orakei Health Centre and Poutiri Trust). Table 2: Pilot providers and locations

Provider Location

Te Hauora O Te Hiku O Te Ika Kaitaia, Northland (joint venture)

Ngäti Hine Health Trust Kawakawa, Northland (joint venture)

Ngäti Whatua O Orakei Health Centre Orakei, Auckland

Te Runanga o Kirikiriroa Hamilton

Poutiri Trust Te Puke, Bay of Plenty

Kokiri Marae Keriana Olsen Trust Petone, Wellington

Hauora Matauraka Christchurch

44 Note that there was also funding in the form of a core budget to cover overheads related to all health service contracts

for each health provider.


Almost all of the pilot provider organisations were originally set up by Mäori. Some were set up for the sole purpose of delivering personal health and health promotion services for local Mäori, while others originally had other focuses, such as providing vocational training for Mäori, and later moved into delivering health services. A description of the pilot providers was included in the first evaluation report (BRC Marketing & Social Research and Te Pümanawa Hauora 2001).

3.4 The training/co-ordination component Te Hotu Mänawa Mäori was contracted to deliver a training and support component to all quit coaches and their managers (BRC Marketing & Social Research and Te Pümanawa Hauora 2001). Key components of this included the following.

• Delivery of initial training hui to train the quit coaches. The four-day training session included an overview of the Tobacco Control Strategies in New Zealand, health statistics for Mäori, as well as sessions on assessing participants’ readiness to quit (using the Stages of Change Model), participants’ smoking history, case management, programme planning, motivational interviewing, cognitive therapy, ethics, and the role of the evaluation. A total of 61 quit coaches received this training over the two-year period of the pilot programme.

• Providing ongoing support and training for quit coaches and pilot provider managers, and encouraging liaison between pilot providers to improve the quality of the service delivered. (The training providers were in constant telephone contact with health providers. They disseminated information, and educational resources on cessation issues and other relevant topics requested by the health providers. The support role included quarterly visits to sites and a co-ordination role that brought provider personnel and other key stakeholders together. Ongoing training included sessions on identifying and working with relapsed clients).

• Arranging quarterly regional hui and annual national hui of quit coaches, pilot provider managers and other key stakeholders to discuss issues of concern and identify possible solutions.


4 Issues Faced in Implementing Aukati Kai Paipa 2000

As a part of the evaluation of Aukati Kai Paipa 2000 a full process evaluation was carried out in order to describe the establishment and implementation of the pilot programme. A full report on the process evaluation was presented in an earlier evaluation report (BRC Marketing & Social Research and Te Pümanawa Hauora 2001). The process evaluation included a formative component focusing on the implementation of the programme by pilot providers as it evolved. The procedures and processes of delivery were observed and described, and key issues were identified. These were fed back to key stakeholders at hui where they were discussed and solutions were identified to address the issues in an effective, uniform and Mäori-appropriate way. Issues dealt with in this way included:

• identifying appropriate participants – those motivated to quit

• lack of information about Nicotine Replacement Therapy

• supply problems with Nicotine Replacement Therapy patches and gum

• issues related to working with hapü women – in particular, whether to use Nicotine Replacement Therapy

• the additional cultural obligations and expectations placed upon those who work within Mäori settings

• the challenge of working with their own whänau, and within Mäori organisations that are not smokefree

• issues related to the Mäori workforce capacity (limited number of smokefree workers and difficulties in recruitment, the need for additional training due to limited experience, the size and complexity of the role of quit coaching)

• Mäori workforce development (the use of a Mäori approach to development – building relationships, sharing expertise and mentoring new staff and new providers)

• the pilot providers’ role in data collection leading to gaps in the data available to the evaluation.

4.1 Identifying appropriate (motivated) participants Pilot providers found it challenging to identify participants who were motivated and ready to quit. This group were relatively difficult to distinguish from those who were a little ambivalent, in that they disliked smoking and wanted to quit sometime, but were not ready to quit just yet. Several strategies were adopted to help draw out which participants were motivated to quit, including:


• placing some responsibility with the participants to initiate appointments with the quit coach, or to participate in a set number of sessions

• ‘testing’ participants’ readiness to quit with ‘preparation work’ or ‘homework’ activities which also gave participants insight into the quitting experience and a better understanding of their smoking behaviour (eg, practising ‘cold turkey’ or ‘reduction’ for half a day, keeping a diary of smoking triggers/urges).

Additionally, over time, quit coaches became practised and expert at interviewing/ counselling participants and were better able to identify those ready to quit now, versus those who would like to quit at some time. Some in this latter group were counselled and became ready to quit. A key success to training new quit coaches in the second year of the pilot programme was having experienced quit coaches facilitate some training sessions to share this knowledge first-hand. See Section 4.6 for further details on this.

4.2 Issues related to the use of Nicotine Replacement Therapy

4.2.1 Lack of information about Nicotine Replacement Therapy A significant problem when the pilot programme first started (at the time of training quit coaches) was the very limited information on Nicotine Replacement Therapy.

• Initially, only information about the use of the Nicotine Replacement Therapy patches was provided by the supplier (Novartis). No information was available on the use of the Nicotine Replacement Therapy gum.

• Information about prescribing Nicotine Replacement Therapy was incomplete. For example, there was limited information about the appropriate dosages of Nicotine Replacement Therapy, how to select an appropriate dosage, or whether it was safe to prescribe patches and gum together.

• The Guidelines to Smoking Cessation (National Advisory Committee on Health and Disability) were published in July 1999, some one to two months after the initial training sessions were completed and pilot providers had started delivering their programme. However, the Guidelines were limited in detail, stating that ‘pregnant and lactating women should be encouraged to attempt cessation without pharmaceutical treatment. If this fails, NRT [Nicotine Replacement Therapy] should be considered and followed closely’. The Aukati Kai Paipa 2000 Training Manual, available mid-1999 during training, made a similar statement.

• At the time of training, and even after the Guidelines to Smoking Cessation were published, few protocols or formal guidelines existed to cover: – handling and storage of Nicotine Replacement Therapy – use of Nicotine Replacement Therapy by pregnant women45 – the role of the general practitioner (GP)/midwife when a participant was

pregnant/lactating

45 There are no large-scale empirical studies on use of Nicotine Replacement Therapy by pregnant women (email

communication, Cochrane Database key contact for smoking cessation research).


– the role of the GP/specialist when a participant was seriously ill (eg, with cardiovascular disease).

4.2.2 Supply problems Throughout the first year of the pilot programme there were problems with the supply of Nicotine Replacement Therapy product to pilot providers, such as delays in the supply of products or out-of-date products being supplied.

4.3 Considerations of working with hapü women Throughout the pilot programme period, pilot providers were concerned about Nicotine Replacement Therapy used by hapü women. Although the pilot programme was designed to target hapü women, pilot providers were not comfortable using Nicotine Replacement Therapy in the face of limited evidence of its safety. Each pilot provider had to consider the issue for their own community and weigh up the options. In general, pilot providers tended not to offer Nicotine Replacement Therapy to women who were hapü, although some provided it to hapü women who particularly wanted to use it, if participants had obtained consent from a medical professional involved in their maternity care (GP, midwife or specialist).

4.4 Working within Mäori settings As indicated in Section 1.3.1 there are additional cultural obligations and expectations placed upon those who work within Mäori settings.

• Obligations to other staff. This includes the need to support others within an organisation by following protocols. For example, if a staff member is expecting manuhiri then it is taken for granted that other staff will manaaki the visitors. This may involve taking part in the powhiri to greet guests (particularly if this is the visitors’ first visit to the organisation), sharing in a meal or greeting the visitors some time during their stay.

If these obligations need to be fulfilled on a regular basis, this can cause tension between cultural responsibilities and the demands of the programme (Ratima 1998). Such demands, however, may be reciprocated when a fellow staff member’s advice or assistance is required. It is this reciprocity among staff that enables staff to support each other and promotes a culturally safe work environment.

• Working with your own whänau. ‘Responsibility and reciprocity are predominant components of Mäori whänau relationships’ (Kingi and Durie 2000).

The responsibilities of working with whänau can be demanding. Responsibilities can include assisting in times of need, improving access to health and other services, and accessing resources to promote good health (Ratima et al 1996). This can place huge demands on staff time and resources with the potential for staff to become overloaded (Ratima et al 1996).


The expectations of kuia and koroua may be greater for other people. This is perhaps because of the ‘high levels of reciprocity’ which can occur within this relationship (Durie 1996).

• Working with a marae/kohanga, etc that is not smokefree. This can be a daunting task given the place quit coaches have within the marae (ie, they are likely to be considered as rangatahi). Working with people at a marae, for example, where the number of smokers can be high and there are no designated smokefree areas, requires quit coaches to be sensitive to protocols and understand the unique way that change occurs within the hapü/iwi of the particular marae. This tends to be achieved slowly in small steps, by encouraging smokers to cut down, and encouraging the setting aside of smokefree areas whilst educating potential clients about the effects of smoking and the help the programme can provide.

4.5 Mäori workforce capacity Capacity-building of Mäori health organisations and personnel is a priority of the health sector (Ministry of Health 2000). The last decade of health reforms has seen the burgeoning development of Mäori health providers. Mäori providers are conscious that many are in developmental mode, and that a small, clinically-trained workforce is in high demand in both Mäori and mainstream settings.

• Recruitment. During the implementation of Aukati Kai Paipa 2000 it became clear that there was a limited workforce available of Mäori, smokefree health workers/ organisations to provide a service such as Aukati Kai Paipa 2000. Most pilot providers were able to recruit personnel for the quit coaching role were non-smokers and who had some health or social service experience. However, most quit coaches had limited or no experience in counselling or cessation services. Furthermore, most quit coaches had not dealt with personal client information before in terms of either collecting or storing it.

• Support and training. The training of quit coaches was initially designed to upskill staff who already had health or social service experience. The evaluation noted that throughout the pilot, in response to a need, a higher than anticipated level of support and training was given to providers and quit coaches to ensure a high-quality programme was implemented. For example, training and advice on collecting and storing personal health information was given.

• Workloads. Given the influx of participants into the pilot programme, together with the intense, long-term support expected by clients and the cultural obligations of staff, the workloads of quit coaches were excessive. The evaluation found that a core team of staff, which included either three or four quit coaches and a co-ordinator based at one location, was considered the ‘ideal’ to enable staff to carry out the role and to provide support for each other. (See Section 17.3 for a description of the ‘ideal’ team and ‘ideal’ provider.)


4.6 Mäori workforce development As Aukati Kai Paipa 2000 evolved, and as a response to the need for greater workforce development, training and support activities began to follow a Mäori development approach. Examples of this approach include:

• whänau relationships built up during the many hui. Coming together at hui enabled the providers to whakawhänaungatanga. These regular hui gave an opportunity for providers to discuss issues, offer solutions and share ideas. Issues, for example, included discussion around whether or not to provide Nicotine Replacement Therapy to hapü women (see Section 4.3). Providers were also able to present and display the resources they had developed for the programme. For example, one provider showed an example of a flip chart they were using when presenting to groups. Many providers saw this as a very useful resource. Also see Section 1.3.6 for more commentary on this issue

• sharing expertise when training new quit coaches during the pilot period. New quit coaches were employed during the initial two-year pilot period to alleviate high workloads or to replace those who had left. Experienced quit coaches took part in training sessions to share their knowledge. This proved invaluable to new quit coaches

• tuakana/teina. This tuakana/teina concept of sharing expertise was so successful that it was to be repeated and developed for training the new Aukati providers after the two-year pilot period finished.46 Tuakana, in its most general sense, means older/mentor, while teina means younger/novice, a relationship of ‘big sister/little sister’ for example. For this programme, the tuakana röpü will be the pilot’s co-ordinators and quit coaches of the original seven Mäori health providers for the Aukati Kai Paipa 2000 programme. The teina röpü will be the new providers of the Aukati Kai Paipa programme. Members of the tuakana röpü will participate in the training of the teina staff. Costs will be kept to a minimum by inviting tuakana to attend training sessions for the teina providers in their area. The teina learn from the experiences of the tuakana.

4.7 The pilot providers’ role in data collection A significant decision made by the Steering Group was to have the pilot providers collect, record and retain ownership of all data relating to participants in the programme. This decision was made for a number of reasons, including the desire to create the competency for data-handling within providers and to allow providers to adopt their own data policies. While the rationale behind the decision was acknowledged, the decision caused concern with the evaluation team and the peer reviewer of the evaluation methodology. It was felt that this approach would provide only limited control over the quality and integrity of the data.

46 This process had already commenced at the time of writing.


Unfortunately, all seven pilot providers did experience difficulties recording and maintaining the information electronically. As a result there was a significant amount of missing data at the three-month, six-month, and 12-month follow-ups (around half was missing). A decision was made by the evaluators, in consultation with the key stakeholders, to exclude data if more than half of the expected data was missing for a pilot provider. See Section 5.2 and Appendix C for further information.


5 Outcomes of the Aukati Kai Paipa 2000 Pilot Programme

The evaluation focused on collecting information in the areas of effectiveness, acceptability and cost, as follows. Effectiveness of the intervention:

• To confirm47 that this intervention is effective in reducing smoking prevalence and (secondarily) in reducing tobacco consumption among Mäori women on the programme. See Sections 5.2 for findings and 5.7 for comparisons.48

• To confirm that this intervention is effective in reducing smoking prevalence and (secondarily) in reducing tobacco consumption among whänau of Mäori women on the programme. See Sections 5.2 for findings and 5.7 for comparisons.

• To determine whether this pilot programme was an effective channel for delivering Nicotine Replacement Therapy and counselling to Mäori women smokers. See Sections 5.3 and 5.5 for findings.

Acceptability:

• To assess the programme’s acceptability among Mäori women smokers and whänau on the programme. That is, to determine whether it is accessible and culturally appropriate. See Sections 5.4 and 5.5 for findings.

Relative cost-effectiveness:

• To collect cost information and process details to inform an analysis of the relative cost-effectiveness of the pilot programme as a smoking cessation intervention for Mäori women smokers. To present an estimate of the cost per quitter on Aukati Kai Paipa 2000. See Section 5.6 for details.

For detailed information: see Appendix D for data tables on the programme, and Appendix E for data tables on the baseline survey. Preceding the presentation of findings are several stories from ‘the Aukati Kai Paipa 2000 whänau’ – a collective term used within the programme for those who participated in Aukati Kai Paipa 2000 and quit coaches who supported their efforts to quit.

47 Internationally this intervention (counselling and Nicotine Replacement Therapy) is a known effective intervention.

This evaluation focus was therefore to confirm it was effective for this population. (A key aspect of confirming the effectiveness was to determine whether the intervention would be acceptable [ie, accessible, culturally appropriate] to Mäori women smokers and their whänau.)

48 See Section 2.1 for fully-defined evaluation objectives.


5.1 Stories of whänau (Mäori participants and quit coaches)

‘I don’t cough like I used to. When I made up my mind, I was determined to QUIT!’ Kuia – Ngati Porou, Te Rarawa (age 72, years smoked: 52).

A comment made by a whänau member ‘You’ll never quit,’ prompted Jean to prove them wrong. ‘The first few weeks I was weepy and had all sorts of aches and pains, but with support and encouragement from the quit coaches I finally quit!’ Whaea – Ngapuhi (Age 64, years smoked: 43).

‘My name is Paul. I am 38 years old, and I have smoked for 19 years. I joined the quit programme in November 2000, after suffering from a heart attack earlier that month. Due to my other health problems I knew if I wanted to see my family grow up, I had to do something about my smoking. Being a dart player, I found it hard to go into a hotel or working-man’s club, where a lot of people were smoking, but I did it. It has been months since I stopped smoking with the support from Tahu and his staff, and also my whänau who have turned our house into a smokefree zone. I have given my leftover patches back to the quit programme and can look forward to a long smokefree life ... thanks.’

Eddie is a 59-year-old truck driver who often smoked while he was driving. Eddie quit smoking a year ago and has encouraged almost 50 other Mäori to ring the coaches and seek help to stop smoking.

Quit coach: ‘At the beginning of this year one of my clients passed away due to illness caused from many years of smoking and drinking and just partying hard. During this assessment for the Aukati Programme he felt remorse about his lifestyle that led to his illnesses, but sincerely desired to quit smoking before he died. He commented, “If there is any good that I could do for myself it is that my wairua be smokefree”. On the day of his passing, he had achieved this goal.

Quit coach: ‘The wife of an old friend remarked that she should get her tane to come and see me as she has been trying for years to get him to quit the ghastly habit. My memory of my friend told me that frogs could fly too. Well, I put him on the programme ... and YES, he disappeared after a couple of weeks. Surprise, surprise, eight weeks after signing him up I got a frantic call from his wife. “Please can you send us some more patches, he hasn’t had a smoke since he started and has run out of patches.”’


5.2 The programme reduced smoking prevalence and tobacco consumption

5.2.1 Quit rate measures and definitions The quit rate measure used in this evaluation was a self-reported quit rate. In collecting this information from participants, a standard definition for smoking was defined to participants, but their reported quit status was not formally verified using carbon monoxide testing or similar. For the purposes of calculating the quit rate, quit was defined as having ‘not smoked for two days’ and not had an ‘occasional puff’. The formula used for the calculation of the quit rate (point prevalence) is as follows:

number of people (n) quit at 12 months 12-month quit rate =

number of people (n) ever on the programme

See Appendix A, Section 6 for further details of the definitions used. The quit rate at six months and at 12 months for the Aukati Kai Paipa 2000 pilot programme was calculated using the data from three pilot providers and four pilot providers respectively (out of a possible seven).49 See Appendix C for full explanation of data usage.

5.2.2 Quit rate for Aukati Kai Paipa 2000 Applying the definition of quit and the formula outlined in the previous section, the quit rate for the Aukati Kai Paipa 2000 pilot programme is: • 26% (23–29%) at six months • 23% (21–25%) at 12 months. The six-month quit rate varied across the three pilot providers (19% [14–24%]; 22% [17–27%]; 32% [28–36%]). The 12-month quit rate varied across the four pilot providers (14% [9–19%]; 21% [17–25%]; 23% [19–27%]; 34% [28–40%]). Mäori women50 had the same quit rate as participants overall (six months 26% [23–29%] and 12 months 23% [20–26%]).

49 Some pilot providers did not collect/record adequate levels of data for quit rate measures to be calculated. Quit rate

data was therefore analysed for those pilot providers who had provided the evaluation team with at least half of the data that they were due to collect.

50 Mäori women make up 66% of those on the programme as they are the target group for the programme.


Table 3: Quit rate

At 6 months total

n=1066

At 12 monthstotal

n=1400

Quit 26% 23%

Not quit / data not available 74% 77%

Total 100% 100%

Further analysis shows that the level and type of intervention made a difference.

• Those who used Nicotine Replacement Therapy at all (patches and/or gum) were slightly more likely (p=0.069 at 95% conf. int., p=0.036 at 90% conf. int.)51 to be quit at 12 months (24% quit) compared to those who did not use any Nicotine Replacement Therapy product (18% quit). There was no evidence that the delivery mechanism (patches or gum) for Nicotine Replacement Therapy made a difference.52

• Overall, the number of times participants received Nicotine Replacement Therapy (either patches or gum) impacted on whether or not they were quit at 12 months:

– There was an optimal level of Nicotine Replacement Therapy. This was a start day dose of one week’s worth of patches/gum plus receiving it a further seven or eight times. This equates to about eight or nine weeks of Nicotine Replacement Therapy as most pilot providers tended to provide one week of Nicotine Replacement Therapy to participants each time they met.

– Those who received Nicotine Replacement Therapy seven or eight times after start day had a higher quit rate (35% quit) than those who received Nicotine Replacement Therapy 16 or more times (22% quit, p=0.02), or those who received it only three or four times (22%, p=0.012) or one or two times (20% quit, p=0.006).

– Those who received Nicotine Replacement Therapy seven or eight times (35% quit, p=0.002), or nine to 15 times (27% quit, p=0.004) after start day had a higher quit rate than those who received no Nicotine Replacement Therapy (18% quit).

• The programme appeared to be just as successful in helping those with different levels of smoking or levels of addiction to tobacco. In total, 26% of the lightest smokers (1–10 cigarettes per day) through to 21–26% of heavier smokers (11–20 cigarettes, 21–30 cigarettes and 31 or more cigarettes per day).

51 This is a significant difference at the 90% confidence interval. It is not significant at the 95% confidence interval.

See commentary in the discussion section on this. 52 Note that too few people used gum alone (n=66) to show whether there is a differential quit rate for the type of

Nicotine Replacement Therapy used.


Those with a low addiction,53 or medium addiction were just as likely to be quit (23–28% quit) at 12 months as those with a high addiction or very high addiction (22–23% quit).

• Those with prior ‘quitting experience’ had more success on the programme. Those who had tried to quit (25%, p=0.009) or tried to cut down (25%, p=0.01) their smoking before going on to the programme were more likely to be quit at 12 months compared to those who had never tried to cut down or quit (17%).

• Living with smokers correlated with lower quit rates:

– Participants with a partner who was a past smoker at start day were more likely to be quit at 12 months (31%), compared with those with no partner (22%, p=0.023), a partner who never smoked (20%, p=0.015) or a partner who was a current smoker (22%, p=0.019).

– Those who lived with more smokers when they started the programme were less likely to be quit at 12 months (p<0.0001) than those living with fewer smokers. Participants who were the only smoker or lived with one other smoker were more likely to be quit at 12 months (24% and 25%), compared to those who lived in a house with four or more smokers (self and three others) (10% quit).

– The intervention, providing Nicotine Replacement Therapy, had a varied impact with those of different ages. The programme appeared to be less effective for those under 20 years of age (just 8% of this age group were quit at 12 months), compared to those aged in their 20s, 30s, 40s, or 50s (p<0.01). Furthermore, those aged in their 40s or 50s were more likely (p=0.019) to be quit at 12 months (28%) compared to participants in their 20s and 30s (22%).

5.2.3 Decrease in tobacco consumption Whilst some participants were not able to quit on the programme, they did change their attitudes and behaviour. They tended to cut down their tobacco intake and made changes such as having a smokefree home:

• Tobacco consumption dropped (p<0.0001). When they started on the programme, 36% of participants smoked over 20 cigarettes per day. This had dropped to 6% at six months and 11% at 12 months.

• Whilst few participants lived with non-smokers or had smokefree environments when they started on the programme, this had changed at 12 months:

– Fewer participants overall reported that their partner was a current smoker at 12 months, compared to the start of the programme (35% at 12 months compared with 41% at start day, p=0.0208). Also, those who were quit at 12 months were less likely to say their partner was a current smoker compared to those not quit (28% at 12 months compared to 38% at start day, p=0.027).

53 Note that lower addiction levels are indicated by a lower level of smoking (eg, under 20 cigarettes per day compared

with over 30) together with a longer period before smoking after getting up in the morning (eg, 30 or 60 minutes compared with five minutes). See Appendix D for a full definition.


– At 12-month follow-up, one quarter of all participants (26%) reported that there were no current smokers living in the household,54 compared to none (0%) at the start of the programme. Half of those who were quit at 12 months reported that there were no current smokers in the household (51%).

– Compared to when they started the programme, many more participants tended to socialise with non-smokers (p<0.0001). At 12 months, one-fifth of participants mixed with people who were mostly auahi kore55 (14%) or were totally auahi kore (6%). At the start of the programme just 11% mixed with people who were mostly auahi kore. Nearly one-third (28%) of those quit at 12 months tended to mix with non-smokers (mostly auahi kore 17%, totally auahi kore 11%).

– At 12 months, participants’ main environments tended to be less smoky (p<0.0001). Of three environments, their home, their car and their workplace, participants reported that they tended to be mostly auahi kore or totally auahi kore (62%, 60%, 59%) rather than mostly auahi kore (42%, 29%, 48%), or half and half (16%, 23%, 25%) as they had reported at start day. These changes occurred even among those who were not able to quit.

I feel good; my baby lives in a smokefree environment. I sometimes have a puff due to stress. The last puff I had was two months ago. Aukati participant (not quit)

My attitude has changed about smokefree as my house is now totally smokefree. Aukati participant (not quit)

I have made my home smokefree and I have cut down smoking also. Aukati participant (not quit)

I do not smoke in the house when my moko are here. Aukati participant (not quit)

I haven’t stopped but made changes at home and my car is totally smokefree. Aukati participant (not quit)

5.2.4 Other (potential) impacts of the programme Mäori pilot providers reported that participants on the programme accessed other health and social services through the programme such as nutrition advice, exercise programmes, counselling services, budget advice, anger management, or checks for asthma, diabetes etc. The majority of participants, especially those who were quit, reported having ‘good changes to their health’ in the 12 months while on the programme (73% quit; 50% not quit). Changes related to a feeling of healthiness, ease of breathing, reduced problems with asthma, etc.

54 The quit rate of 23% at 12 months takes into account those not followed up at 12 months, whilst the figure of those

reporting no current smokers in the household includes only those who were followed up, and who were asked all the 12-month follow-up questions.

55 Assumed to include any that were totally auahi kore at start day.


I play netball in and outdoor and my breathing is great. I love it. Aukati participant (quit)

Breathing eases, no pain in chest, fitter, feel overall healthier. Aukati participant (quit)

No smelly smoke on my breath, clothes and home. Better breathing, no coughing. Aukati participant (quit)

Save money. Smokefree whare. Asthma more controlled (children’s). I feel special. Aukati participant (quit)

I have put weight on which I needed to. Feel much healthier, look better and have more money. Aukati participant (quit)

Just 10% reported ‘bad changes in health’ (9% of those quit, 10% of those not quit at 12 months). Changes reported by participants included weight gain, feeling more stressed, problems with pre-existing illness, and those that are related to withdrawal.

Weight gain. Aukati participant (not quit)

Good – smell clean, no bad breath, healthier, fitter, breathing easier. Bad – putting on weight, grumpy, moods, stressed out. Aukati participant (not quit)

Gain weight, mood swings. Aukati participant (quit)

I have put on weight. Aukati participant (not quit)

Coughing – take longer to recover from illnesses. Aukati participant (not quit)

Good changes: Breathing much better, blood pressure down. Bad changes: Weight gain/diabetes. Aukati participant (quit)

Good: Health, breathing, money, smell. Bad: Stress, anxiety. Aukati participant (not quit)

Over half of Aukati Kai Paipa 2000 participants lived with children under five years old (57%). Many of these participants changed their smoking behaviour while on the programme.

• At start day 47% of those living with children under five years had said their home was mostly auahi kore (assumed to include totally auahi kore).

Half of those quit at 12 months (51%) living with children under five years indicated that their home had become totally auahi kore, and a further 22% said it was mostly auahi kore (p<0.0001).

Even those that were not quit at 12 months made big changes (p<0.0001). A third (33%) of those not quit at 12 months living with children under five years indicated that their home was totally auahi kore, and a further 27% said it was mostly auahi kore.

I have made changes to my lifestyle, totally no smoking around my kids. Aukati participant (not quit)

I have made changes about smoking and around my baby. Aukati participant (not quit)


• Those living with children under five years made similar smokefree changes with their car (p<0.0001). At start day just 30% of those living with children under five years had said their car was mostly auahi kore (assumed to include totally auahi kore).

Two-thirds (65%) of those quit and a third (32%) of those not quit reported that their car was totally auahi kore at 12 months. A further 16% and 19% respectively reporting their car was mostly auahi kore).

5.3 The programme delivered both Nicotine Replacement Therapy and counselling to Mäori

The programme delivered both Nicotine Replacement Therapy and counselling to most participants. Note that pilot providers were unable to accurately record data about prescriptions and contacts with participants, ie, the number of prescriptions and contacts recorded is somewhat underestimated in the database. (See Footnote 58 and Appendix A, Section 8 for further details.)

5.3.1 Most participants used the free Nicotine Replacement Therapy and all received counselling

Most participants (89% [88–90%]) commenced using Nicotine Replacement Therapy soon after being assessed as appropriate (motivated to quit, etc) to go onto the programme. Quit coaches reported that some of those recorded as not starting Nicotine Replacement Therapy soon after starting the programme spent two to four weeks preparing to quit prior to setting a quit date and then started Nicotine Replacement Therapy. A few participants did not use Nicotine Replacement Therapy due to a contraindicating condition (being hapü, etc).

• The Nicotine Replacement Therapy used tended to be patches (83% of all participants), rather than gum (52% of all participants).56 Many used both gum and patches (47% of all participants).57

• Those who received Nicotine Replacement Therapy tended to receive it at least58 five times (59%) after start day (ie, start day dose of one week and five further occasions).

56 A very small proportion of participants on Aukati Kai Paipa 2000 (the exact number is unknown) who were more

heavily addicted to tobacco used two patches at the same time, thus using two packs of patches each week for the first few weeks they were using Nicotine Replacement Therapy.

57 Observations and discussions with quit coaches indicate that while some participants used patches and gum at the same time (mainly those who were very heavily addicted to tobacco), many participants who used both forms of Nicotine Replacement Therapy tended to first use patches alone for four, eight or 12 weeks and then use gum alone for a few more weeks.

58 ‘At least’ refers to the fact the number of times participants received Nicotine Replacement Therapy was under-recorded by an unknown amount. We know that 89% of participants were prescribed Nicotine Replacement Therapy soon after they were assessed, but data on number of times Nicotine Replacement Therapy was provided to each participant was recorded for only 55% of all participants.


• Those who received Nicotine Replacement Therapy in the form of patches tended to receive at least59 three packs (71%) after start day (ie, start day dose of one week and at least three further packs). A pack of patches tended to be used in one week.60

• Those who received Nicotine Replacement Therapy in the form of gum tended to receive fewer packs of gum compared to the number of packs of patches those on patches received, although this varied. One third of those receiving Nicotine Replacement Therapy received no gum (30%), a quarter received one to four packs of gum (25%), and over a quarter (28%) received nine or more packs of gum. A pack of gum would be used up at different rates depending on the users’ addiction level, and whether they used patches at the same time.61

Quit coaches reported that processes developed for the programme meant that, as a rule, all participants received counselling, either on its own or as an adjunct to collecting their Nicotine Replacement Therapy each week. Quit coaches tended to have at least weekly contact with participants while participants were on Nicotine Replacement Therapy. Exceptions to this included instances where a participant was going away on holiday (so they would get enough Nicotine Replacement Therapy for the holiday period), lived a particularly long distance from the quit coaches (so they would get enough Nicotine Replacement Therapy for a fortnight, or would pick it up from a district nurse), or when arrangements were made for the client to pick up their weekly Nicotine Replacement Therapy from the pilot provider when the quit coach was unavailable. Several pilot providers developed processes where they provided one or two introductory educational/counselling sessions (one-on-one or in groups) prior to start day when potential participants were interviewed and assessed to go on to the programme. The number of contacts quit coaches had with each participant was far more than anticipated, and lasted far longer than anticipated. Furthermore, the nature of these contacts was that they were not always planned, but happened incidentally because the quit coaches lived in the community to which they were delivering the service. Note that data recorded by pilot providers is likely to underestimate the number of contacts that actually occurred between quit coaches and participants.62

• Participants tended to receive one to three contacts with quit coaches that were not captured by the data collection processes as they did not occur after the start day (ie, the contact when they were assessed to go on to the programme plus one or two introductory sessions).

59 See Footnote 58. 60 See Footnote 58. 61 See Footnote 57. 62 Pilot providers’ data on contacts with participants tended to be incomplete (ie, underestimated the number of contacts

with each client) due to the burden of maintaining detailed data records of such frequent contacts.


• At least63 60% of participants received five or six contacts or more after start day. The number of contacts recorded per participant varied, with one pilot provider typically recording many contacts per participant (one recorded 61% of their participants received nine or more contacts), and other pilot providers tending to record fewer contacts (three recorded 47–71% having one to four contacts).

• These contacts tended to mainly be by one-on-one meetings (at least64 69% of participants received these), phone calls (58%), group sessions (30%) or informal meetings (26%). Participants tended to receive a mixture of different types of contact.

5.3.2 The programme was perceived as more helpful than others After experiencing the programme almost all participants felt that it was more helpful than other options.

• After three months, most participants thought the programme was much more helpful (94%) or a bit more helpful (4%) than other programmes or other ways of quitting.

• After six months, everyone thought the programme was more helpful (much more helpful 92%, a bit more helpful 5%, don’t know 2%).

• After 12 months, most participants thought it was more helpful (much more helpful 80%, a bit more helpful 10%, don’t know 5%).

• Those who were not quit at follow-up still tended to think the service was much more helpful than other options (90% of those not quit at six months, 75% of those not quit at 12 months).

Those who had experienced using Nicotine Replacement Therapy products prior to Aukati Kai Paipa (including gum, patches, nasal spray or inhaler), or who had used the Quitline, felt that Aukati Kai Paipa65 was much more helpful (86% at three months, 87% at six months, and 87% at 12 months) or a bit more helpful (11% at three months, 10% at six months, and 8% at 12 months).

I really want to stop and feel confident with the support of the programme and my whänau. Aukati participant (at start day)

Not a militant approach – very understanding on how difficult it is with humour and tolerance. Aukati participant (at 12 months)

The programme was helpful to me and I was a long hardened smoker. Thank you to coaches for your genuine and professional manner. Aukati participant (at 12 months)

Everybody’s help made my confidence lift. Thank you. Aukati participant (at 12 months)

63 ‘At least’ refers to the fact the number of contacts with participants was under-recorded by an unknown amount. 64 See Footnote 63. 65 Between one-third and a half of participants interviewed at the successive follow-ups reported using these cessation

products or Quitline prior to going on the programme.


This programme was helpful to me as I was able to quit even though I didn’t use the patches the full eight weeks. I also enjoyed the support from the quit coach. Aukati participant (at 12 months)

The pilot providers were able to recruit whänau of participants onto the programme, including those living in the same household.

• Half of participants (46%) reported they had whänau already on the programme when they started (some would also have had whänau join the programme after them).

• One quarter of participants (26%) were on the programme with someone else in their household.

Both my husband and myself gave up smoking at the same time with this programme. Aukati participant

My daughter started on the programme with me so we could do it together. Aukati participant

5.3.3 Participants found support among friends and whänau Participants tended to feel supported by their whänau and friends.

• Three months after starting on the programme most participants indicated that whänau and friends were very supportive (71%) or a bit supportive (11%). At six months participants reported similar levels of support (67% and 12%).

• Those who were not quit at three or six months reported lower levels of support (p<0.0001) from whänau and friends at follow-up (very supportive 63% and 59% or a bit supportive 12% and 13% at three and six months), compared to those who were quit (very supportive 82% and 80% or a bit supportive 9% and 9% at three and six months).

5.3.4 Lack of access to other cessation services/products Participants on this programme tended not to have used any cessation products before and, even though they were aware of Quitline, they had not tended to use the service:

• The majority of participants had not used Nicotine Replacement Therapy products (75%) prior to starting the programme. Some (19%) had used nicotine patches and/or nicotine gum before.

• Awareness of the Quitline service was reasonably high. Just over half of the participants knew of Quitline (60%).

• Few participants (10% of all participants) had used the Quitline service prior to starting on the programme. Most who had used it talked to Quit advisors, and/or requested a ‘Quit pack’.66 Typically, they had used the Quitline in the six months prior to starting on the programme (77%).

66 Most participants (82%) commenced Aukati Kai Paipa prior to Quitline providing Nicotine Replacement Therapy in

their area (ie, before May 2000 for those in Hamilton, Bay of Plenty, or before November 2000 for the rest of the participants), so the ‘quit packs’ they received would have included advice in the form of a quit book, etc, not Nicotine Replacement Therapy.


• Very few participants reported using Quitline or other cessation services or products after starting on the Aukati Kai Paipa 2000 programme.67 – Few used other products, methods or other support (3% at three months, 4% at

six months). – Few had used Quitline since starting on the programme (3% at three months,

3% at six months). – Few used patches or gum from outside of the programme (2% at three months,

1% at six months).

5.4 Was the programme acceptable? Evidence of how accessible and culturally appropriate it was for Mäori

In addition to reviewing the perceptions of the programme participants and quit coaches, we have adopted the He Taura Tieke framework for measuring effective health services for Mäori to determine whether the pilot programme was acceptable (Ministry of Health 1995). From a Mäori consumer perspective, six issues are important. Access • Barriers to access for Mäori are removed by:

– providing the service locally or from within the community – providing a culturally-acceptable service – addressing consumers’ financial needs.

Information • Providers:

– communicate successfully with Mäori by giving clear information about the service

– collect information from Mäori consumers sensitively, keeping confidentiality – use information sensitively to benefit the Mäori consumer.

Informed choice • Mäori consumers make informed choices by:

– being given options sensitive to their needs – receiving useful information from the provider to assist in making choices.

Trust and respect • Mäori consumers feel respected and, in turn, trust the provider who:

– maintains their privacy and confidentiality – provides the best possible care available – respects cultural and lifestyle differences.

67 One pilot provider did not record this data accurately so data is excluded from analysis for these questions (n=400–500,

margin of error is ± 1.0% to 1.8% on reported proportions).


Participation

• In addition to being part of the service workforce, Mäori are involved in management decisions and may have a stake in owning the health services.

Seamlessness • Health care is comprehensive, integrated and continuous. There is continuity of staff

where practicable. Individual consumers and their whänau are able to be clients. Considering each of the six issues outlined above in turn, a variety of evidence has been collected to allow analysis of the appropriateness of the service for Mäori, as follows.

• Access: Both the intended programme design and the efforts of pilot programme staff meant that many barriers to access were removed, especially by running the programme in Mäori venues and addressing financial concerns through direct subsidisation (see Chapter 1 describing the service, and Sections 5.4.2 and 5.5 describing participants’ access to the pilot programme).

• Information: Information for the programme and the evaluation was collected by Mäori quit coaches and held with each pilot provider. The information was collected in ways that were both ethically and culturally sound, generally being collected face-to-face or sometimes by telephone once the participants had come to know the quit coaches. Information was used directly to deliver the programme to participants and to evaluate its success. Evaluation information was fed directly back to pilot providers in order to develop the programme to better meet participants’ needs and so that the programme might be expanded into other Mäori communities.

• Informed choice: Participants were clearly informed of the details of the programme and the evaluation when they were recruited. The programme delivery was diverse and accommodated the varied needs of Mäori communities (see Section 5.5). Information about the programme (including the history of smoking by Mäori, effects of smoking, the effects of cessation and the use of Nicotine Replacement Therapy products) was presented orally and visually as well as in writing in a Mäori-appropriate way through group sessions, waiata, specially-designed flip charts and Mäori artwork, etc – see Section 1.3.5.

• Trust and respect: Both the staff and participants felt that the programme was delivered in a unique Mäori way that enhanced respect and trust (see Section 5.4.1 below for verbatim comments). Participants reported a high level of confidence in quitting on the programme and rated the programme highly in terms of helpfulness relative to other ways of quitting (see Section 5.3.2).

• Participation: The programme was delivered within Mäori services governed and owned by Mäori (see Sections 1.1.4 and 3.3 for details). The programme was provided by quit coaches who are Mäori. Clients felt welcomed and that they were a ‘part’ of the programme (see Section 5.4.1 below for verbatim comments). Several participants who quit on the pilot programme were later employed as quit coaches.

• Seamlessness: The programme was based within holistic service settings which welcomed individuals and whänau alike. Procedures and networks were developed to respond to the diverse needs of participants (see Sections 1.3.2 and 1.3.3).


5.4.1 Both participants and quit coaches perceived the programme was acceptable

Quit coaches felt safe and supported to deliver the services in a culturally-acceptable way.

Wonderful dynamics in group sessions. I’ve found that Mäori doing the quit coaching have more chance of getting better contact and continue to have a better relationship with clients. Quit coach

It is provided by Mäori, is culturally appropriate and easily understood by participants. Quit coach

As a quit coach and being Mäori it has been easy as Mäori think alike and we’ve got this uncanny way of thinking and talking. Quit coach

Clients reported feeling welcomed and safe in using the service.

I think it’s a ‘good thing’ that there is a place that offers a healthy lifestyle and options specific to Mäori. Aukati participant

Supportive, explained, walked through everything, and brown. Aukati participant

When we all get together, listening to others’ stories. Aukati participant

Sharing difficulties and triumphs with others in the group. Aukati participant

Sessions don’t feel alone, whänau support. Aukati participant Participants generally felt that the service was right for them, and even if they relapsed they felt able to return and seek help a second time.

Grateful to be given another try, feel better prepared to quit this time. Aukati participant

I started smoking again because a whänau member was killed in a car accident and my grandchildren are always getting into trouble. The quit coaches are very supportive and have always phoned to see how I am getting on. Have asked many times would I like to come back onto the programme but have not been ready. Aukati participant

Although I relapsed they were non-judgmental and encouraged me to rejoin the programme. Infinite support. Aukati participant

It’s the longest I have managed not to smoke since I was ten years old. I intend to try again and hope the programme will be there. He mihi nunui tenei ki a koutou. Aukati participant

5.4.2 Many barriers to access were removed The service delivered by pilot providers removed many of the typical barriers to health services faced by Mäori.

• The service was free of charge.

– Pilot providers did not charge participants for any aspect of the service.


– During the planning phases of the programme, pilot providers educated local GPs about the Nicotine Replacement Therapy usage and programme. In many instances this meant that participants with significant health issues avoided a full consultation with GPs when gaining consent to use Nicotine Replacement Therapy (thus avoiding consultation fees).

– Pilot providers also reported developing networks with other health and social service providers that delivered free services so that any referrals made tended to be free.

Encouragement, support and free. Aukati participant

I am glad I was on it. As a Mäori woman there was something for me. Grateful you were here – Mäori for Mäori and free. I feel really privileged to take part and still be there on the programme. Aukati participant

Having the opportunities available. Free access. Really positive for Mäori women. Positive network also. Aukati participant

Really good programme – couldn’t afford patches etc ... will come back. Aukati participant

Good programme for Mäori people and that it’s free. Aukati participant

Pai tenei mo tatou te iwi Mäori. Aukati participant

I never want to go back to smoking. This was a great programme and I really appreciated being able to join Aukati Kai Paipa. Aukati participant

Research with Mäori women quitters not on Aukati Kai Paipa 2000 (baseline survey)68 showed that accessing Nicotine Replacement Therapy and the cost of this was an issue for Mäori women smokers in general.

– The baseline survey showed that few Mäori women quitters tried Nicotine Replacement Therapy products to help them quit (20%). Most tried techniques such as support from friends/whänau/workmates (61%), cutting back (57%), drinking water (52%), exercise (46%) or nothing (26%).

– Most Mäori women quitters (baseline survey) who did use Nicotine Replacement Therapy/non-nicotine products had to pay full price for the products (70%).

– The baseline survey also showed that most of those who had to pay to get Nicotine Replacement Therapy products (73%) would have found it easier if they did not have to pay (much easier 65% or a little easier 8%). Just 27% said it would have made no difference.

68 As a part of the evaluation, baseline research was carried out to measure quitting rates among Mäori women not on

Aukati Kai Paipa 2000. In total n=411 (those who had quit in the past year or who were trying or planning to quit within the next three months) were interviewed.


• There was flexibility on the venue of delivery of the programme.

– Most pilot providers delivered their programme in a variety of locations. Pilot providers reported meeting clients in groups or one-on-one at health clinics, the local marae, at education institutes, at workplaces, or at the client’s home. Service delivery included providing the Nicotine Replacement Therapy products directly to participants.

(Nicotine Replacement Therapy) collected at the group meeting. Aukati participant

Did not have to go and pick them up. Megan would drop Nicotine Replacement Therapy in. Aukati participant

– Pilot providers arranged weekly/fortnightly delivery of the Nicotine Replacement Therapy to the participants if they had a long distance to travel or had mobility/transport difficulties (a mobile nurse took it with them, or a single participant collected the Nicotine Replacement Therapy for their whänau group from an agreed pick-up point, etc).

Quit coach always rings before supply runs out, and arranges time (for me) to collect next supply. Aukati participant

– Some participants did experience difficulties getting to group support sessions. As the programme developed, more participants were offered individual or telephone-based support to overcome this:

I have been unable to attend any group sessions because of the distance and also work during the day, would have liked to join in group sessions, possibly in the evening and closer to home. Aukati participant, researcher interview

I am managing to attend sessions but time and place could be more flexible especially for group sessions. Aukati participant, researcher interview

• The service was provided in familiar, accessible locations, and was delivered face-to-face.

In rural areas you have a central base which is your work place but that is not your central base for quit coaching. You have to pick a place which is central for the people. You only have to be there two days per week. Setting up in a place like Plunket or a Mäori organisation enhances the smokefree and quit smoking feel. Quit coach

[The programme is better than others] compared to cold turkey, couldn’t afford patches, have tried Quitline before and found it too impersonal. Quit coach support for this programme is awesome. Aukati participant

Was very pleased the Aukatitia Te Kai Paipa69 was included in the course at the marae. Aukati participant

We were very grateful to have programme at the marae. So we could participate. Aukati participant

69 This was the name of the programme used locally by one of the pilot providers.


Some participants interviewed directly by researchers within the first four weeks of starting on the programme had comments about how the service could be improved in some way to better meet their needs:

Quit coaches should take clients straight away (client referring to being told to think more about giving up before joining programme). Aukati participant, researcher interview

Almost overloaded with information, posters, stickers, and written material. Aukati participant, researcher interview

The [support] groups could be smaller. Aukati participant, researcher interview

Night [support group] sessions would have been better, more suitable. Aukati participant, researcher interview

They [quit coaches] were too soft, provided passive advice which was not enough for me. Aukati participant, researcher interview

[Quit coaching support was] not long enough. I would like to stay in contact with quit coach after eight weeks, could have done with more sessions. Aukati participant, researcher interview


5.5 The programme was accessed by diverse Mäori communities

5.5.1 Demographic profile – start day The following is a demographic profile of participants using firstly physical descriptors, then socioeconomic factors (see Appendix D, Section 2 for data tables):

• The target population for the Aukati Kai Paipa 2000 programme was Mäori. Two thirds of Aukati Kai Paipa 2000 participants fitted into this group (66%, 64–68%). Other participants included the male partners and some non-Mäori whänau of women on the programme.

• Participants tended to be ‘30 somethings’, or older rather than in their twenties or teens. Nearly three-quarters were between 31 and 50 years of age (55%) or 51 and over (17%). Just 21% were aged 21–30 years, and 6% were under 20 years old.

• Most female participants (83%) had children of their own.

• Around two-thirds of participants (65%) lived in a major urban centre.70 One-quarter (25%) lived in minor urban centres, and a few lived in rural centres or rural locations (7%).

• A quarter of participants (24%) had health issues71 that required consideration prior to using Nicotine Replacement Therapy and could have excluded them from using it. Nearly one in eight had asthma (13%) for which they were taking preventative medication, high blood pressure (8%) or cardiovascular disease (3%). Even though a secondary target population for the pilot programme was pregnant women, very few participants were pregnant (2%) or were breastfeeding (2%) at the time they started on the programme.

• In the three months prior to starting on the programme a little over a third of participants (37%) had talked to other health professionals about their smoking, their breathing or their heart.

Socioeconomic indicators (household size, education, income descriptors):

• Most participants had attended high school (81%), but a small yet significant proportion (10%) had no high school education. A third of all participants (35%) had attended tertiary educational institutions.72

• Participants’ household sizes varied considerably. Whilst a quarter lived in small households, living alone (7%) or with one other person (17%), nearly one quarter lived with five other people (10%) or more than five other people (12%).

• Over half of all participants (57%) lived in a household with children under the age of five (not necessarily their own children).

70 For the pilot these included Whangarei, Auckland, Hamilton, Wellington, Christchurch, Rotorua, Gisborne, etc. 71 Health issues such as being hapü, currently breastfeeding, or currently taking medication for cardiovascular disease,

asthma or high blood pressure. 72 Whether participants had gained formal educational qualifications was not collected. Quit coaches felt it was

inappropriate and insensitive to collect this information during a face-to-face interview to assess potential participant readiness to quit.


• Nearly half of participants (48%) were unwaged,73 the rest were working (full-time 30%, part-time 16% or were self-employed 5%). Others, some of whom worked part-time, were students (13%), retired (3%), full-time homemaker (11%), unemployed (10%), or other beneficiaries (18%).

• Two-thirds of participants had a community services card (65%).

• Some participants did not have a telephone (10%). The proportion with no telephone varied across different regions (with 4% to 18% having no telephone).

5.5.2 Smoking environment – start day Participants lived and worked in relatively smoky environments and tended to live and socialise with smokers.

• Nearly half of all participants had a partner who was a current smoker (41%). A third had no partner (32%). So of those with a partner, 60% of their partners were current smokers at the time the participants started on the programme.

• About two in three participants (59%) lived with other smokers.

• Most participants interacted with a lot of smokers, especially those they socialised with. Very few participants indicated that people they mixed with socially were mostly auahi kore (11%). The people participants lived with, worked with and mixed with socially tended to be either mostly smokers (42%, 38% and 54%) or around half and half (20%, 35%, and 35% respectively).

• Most participants tended to spend time in smoky environments, even their workplaces. Three environments, their home, their car and their workplace, tended to be mostly smoky74 (41%, 49%, 27%), or half and half (16%, 23%, 25%) rather than being mostly auahi kore (42%, 29%, 48%).

5.5.3 Smoking/quitting history – start day Participants tended to be longer-term smokers with a high enough addiction to tobacco to suggest Nicotine Replacement Therapy would be useful in a quit attempt.

• Aukati Kai Paipa 2000 participants smoked a median of 15 cigarettes a day at the time they started on the programme. Most participants smoked more than 10 cigarettes a day (76%, 74–78%). A little under half smoked 11–20 cigarettes a day (40%, 38–42%), a quarter smoked 20–30 cigarettes a day (equivalent to ‘a pack a day’) (25%, 23–27%), whilst a further 11% (10–12%) smoked 31 or more cigarettes a day.

Mäori participants were no more likely than non-Mäori participants to smoke more than 10 cigarettes a day (76% and 78% respectively).

73 ‘Unwaged’, those who were not self-employed, or part-time or full-time employed. 74 It is unclear whether participants mean that their workplace is ‘mostly smoky’ inside or outside a building, but it is

probable that at least some people are referring to smoking inside buildings at their workplace.


• Half of participants had a high addiction (41%, 39–43%), or very high addiction (8%, 7–9%), a further third had a medium addiction (38%, 38–40%), with few having a low addiction (13%, 12–14%). Note that lower addiction levels are indicated by a lower level of smoking (eg, under 20 cigarettes per day compared with over 30) together with a longer period before smoking after getting up in the morning (eg, 30 or 60 minutes compared with five minutes).75

• Participants tended to be very long-term smokers who started smoking at a young age. – Almost all had been smoking for more than 10 years. Whilst two-thirds of

participants had smoked for between 10 and 30 years (10–19 years [31%] or 20–29 years [30%]), a further quarter had smoked for more than 30 years – 30–39 years (16%), 40–49 years (6%), or 50–59 years (1%).

– Almost all started smoking before they were 20 years old, with half starting under 15 years old (44%) and half starting at 15–19 years old (45%).

Almost all participants (86%) had tried to curtail their smoking some time in the past with limited success.

• Nearly half had tried to stop smoking completely (41%) some time in the past. Others had tried to cut down smoking (45%).

• Of those who tried to stop completely many tried once or twice (56%), but some had tried numerous times (five, six or more, or too many to count – 17%).

• Details of recent attempts (in the past three years) to stop completely show that participants were unsuccessful over a year: – One-third (32%) had tried to stop smoking completely in the past three years. – In their last quit attempt before Aukati Kai Paipa 2000, most participants

(74%) were smoking again within three months, and all (100%) were smoking within 12 months.

• Respondents tended to be confident that they would be able to stop smoking in the eight weeks they were on the Aukati Kai Paipa 2000 programme. – Using a seven-point scale, 95% said they were reasonably confident (‘4’)

through to very confident (‘7’) that they would be able to quit.

5.6 Cost information – estimate of cost per quitter The objectives of collecting information relating to the cost of delivering Aukati Kai Paipa 2000 were two-fold:

1. To calculate an estimate of the cost per quitter on Aukati Kai Paipa 2000.

2. To inform an analysis of the relative cost-effectiveness76 of the Aukati Kai Paipa 2000 programme to be carried out by the Ministry of Health.

75 See Appendix D for full definitions of addiction levels. 76 Relative to alternative smoking cessation interventions in New Zealand.


5.6.1 Cost information collected from one pilot provider Note that cost information was collected and analysed in regard to one pilot provider selected by the Health Funding Authority. Cost per quitter is therefore calculated for only this provider and may not be representative of the other six pilot providers. All cost information was collected for a 12-month period (the 1999/2000 financial year). See Section 3.2 for a full description of the way the programme was funded.

5.6.2 Approach – cost per quitter The following steps were taken to collect information and analyse data in order to estimate the cost per quitter.

1. We identified that to estimate the cost per quitter, process and outcome information was required as well as cost information: – process information about service delivery – participant recruitment data (number of participants) – outcome data (quit rates).

2. We also identified the need to determine indirect costs as well as direct costs. There were two types of indirect costs: – costs that were met from the providers’ core budget (as opposed to the

programme budget) relating to office rental or rates, office furniture and equipment, telephone line rental and reception resources

– other costs such as services provided gratis or on a subsidised basis (eg, Mäori maintenance costs – koha, kaumatua services or volunteered overtime of staff).

5.6.3 Assumptions – cost per quitter analysis In estimating the cost per quitter, a number of assumptions have been made.

• It was assumed that all participants received Nicotine Replacement Therapy. This may be a slight overestimate. We know that 89% received Nicotine Replacement Therapy at start day and that many of the rest received it in the following weeks. For three other pilot providers with data on this, almost all participants (99%) received Nicotine Replacement Therapy.

• The amount of Nicotine Replacement Therapy used by each participant is assumed to be ten weeks worth, at a cost of $140 per person. For three other pilot providers with data on this, Nicotine Replacement Therapy averaged out at 5.4 packets of patches and 5.2 packets of gum. Note that this is an average – as some 30% of participants received no gum and 7% no patches.

• Cost per quitter is based on ongoing operating costs (including some items covered by the core budget) and a proportion of the establishment costs are one-offs. Establishment costs for the pilot provider were $10,000, excluding core budget items such as office furniture and equipment. These have been annualised at the rate of $2000 for five years, therefore the establishment costs have been allocated at $2000 for Year One.


• Assumptions have been made about the sustainability of indirect costs. – Some indirect costs may be sustainable in the long term. They include

volunteer time (other than staff), administrative tasks carried out by referral agencies, volunteer time by ‘expert’ speakers, and access to meeting spaces after hours for participant celebrations as well as costs covered by the core budget.

– Other indirect costs are probably unsustainable in the long term. These include costs that are somewhat easier to quantify and so are easily recognised as having a specific value by those providing them. For example, regular overtime by quit coaches and transport costs such as car leases.

• The following assumptions have been made about the value of the ongoing operational costs: – The team should include a manager (one full-time equivalent [FTE]) and quit

coaches (3 FTE) who are adequately remunerated for their roles. Cost: $135,000. (In total, wages of $72,000 were actually paid.)

– Transportation is required (two lease cars and petrol). Cost $22,000. (Transport of $6500 was actually paid, ie, lease of one car.)

– Rent and most utilities (power, water, telephone line rental) covered in the core budget are ongoing operational costs. Cost: $45,000.

5.6.4 Cost of the programme The following table outlines the ongoing operating costs delivering Aukati Kai Paipa 2000 for the period from April 1999 to March 2000 (the 1999/2000 financial year).


Table 4: Costs of Aukati Kai Paipa 2000 for one pilot provider

$

Fixed overhead costs

Power, water, rental, building security 45,000.00

Receptionist (shared over 10 contracts) 3,000.00

Telecoms (two land lines) 1000.00

Fixed direct costs

Personnel costs 71,800.00

Car lease (one car) 6,500.00

Petrol (one car) 4,500.00

20% of establishments costs77 2,000.00

Variable direct costs

Cost of Nicotine Replacement Therapy (10 packets, $140 for 329 participants) 46,060.00

Telecoms (cell phone cards, reimburse staff home toll calls) 1,600.00

Other (celebration hui with participants, clerical help, postage/courier, koha) 3,000.00

Drink bottles with ‘educational messages’ – participant incentives 4,230.00

Variable indirect costs (subsidised from core budget/other providers or provided gratis)

Additional personnel costs 63,200.00

Additional car lease costs (one car) 6,500.00

Petrol (one car) 4,500.00

Total 262,890.00

5.6.5 Cost – cost per quitter Aukati Kai Paipa ‘quit’ definition:

• Given a total of n=46 quitters at 12 months, over the 12-month period (1999/2000 financial year), and the costs of $262,890.00, the cost per quitter is $5715.00.

This cost per quitter is based on the number of participants who reported that they had not smoked for two days and did not have an occasional puff.

Less conservative ‘quit’ definition:

• Given a total of n=61 quitters at 12 months, over the 12-month period (1999/2000 financial year), the cost per quitter is $4309.67.

This is using the less conservative quit measure based on the number of participants that reported that they had not smoked for two days (they may have had occasional puffs). This is a measure like that used in evaluation of Quitline New Zealand and Quit For Our Kids.

77 Establishment costs such as recruitment and internal training, programme stationery, etc (excludes some

organisation-wide overheads such as office rental or council rates on property which were covered by the core budget).


5.6.6 Cost – cost per quitter or cut down <10 cigarettes/day In addition to considering the cost per quitter it may be useful to consider the cost per quitter as well as the number of participants who would experience the health benefits of smoking fewer than 10 cigarettes per day, as follows. Aukati Kai Paipa ‘quit’ definition:

• Given a total of n=46 quitters and n=52 who had cut down to less than 10 cigarettes per day at 12 months, over the 12-month period (1999/2000 financial year), the cost per person quit or cut down is $2682.55.

Less conservative ‘quit’ definition (like Quitline New Zealand or Quit For Our Kids):

• Given the total of n=61 quitters and n=52 who had cut down to less than 10 cigarettes per day at 12 months, over the 12-month period (1999/2000 financial year), the cost per person quit or cut down is $2326.46.

5.6.7 Considerations for the cost-effectiveness analysis Given that those using this programme did not tend to access other cessation services, analysis of the cost-effectiveness of Aukati Kai Paipa 2000 should be considered specifically in relation to the population of Mäori women smokers (and their whänau) as described by the demographic profile of those using this programme. Although many participants were aware of the Quitline service, few chose to use that service. This suggests that the two cessation programmes (Quitline and Aukati Kai Paipa 2000) may have almost mutually exclusive client bases and that Aukati Kai Paipa participants are probably a hard-to-reach group that does not readily access other available cessation programmes.


5.7 How does Aukati Kai Paipa 2000 compare?

5.7.1 The baseline survey shows that Aukati Kai Paipa 2000 has a significant impact

The quit rate achieved by Aukati Kai Paipa 2000 exceeds the latent quit rate78 as measured by the baseline survey of Mäori women not on Aukati Kai Paipa 2000.

• The self-reported latent quit rate, over a 12-month period, for the female, adult Mäori population is 12.5% (10.7–14.3%).79

• Aukati Kai Paipa 2000 has had a significant impact on smoking prevalence. The point prevalence quit rate achieved with this programme is two to three times that achieved without the programme. – Nearly one-quarter (23%, 20–26%) of Mäori women on the programme quit at

12 months (ie, quit = those who had not smoked for 2 days at the 12-month follow-up and did not report having any occasional puffs. Not quit = those smoking at 12-month follow-up, those who had occasional puffs or who were not spoken to at follow-up).

– Using a less conservative definition for quit and not quit that is comparable with the baseline survey (and other research), nearly one-third (29%, 26–32%, n=970) of Mäori women on the programme were quit at 12 months (ie, quit = those who had not smoked for two days at the 12-month follow-up and may have occasional puffs. Not quit = those smoking at 12-month follow-up or who were not spoken to at follow-up).

• The latent quit rate (12.5%) over a 12-month period for the female, adult Mäori population is significantly less than the quit rate for programme participants overall (23% p<0.0001) and for Mäori women who were programme participants (23% p<0.0001). Clearly, the latent quit rate (12.5%) is significantly less than the less conservative measure of 29% quit (p<0.0001).

78 By ‘latent quit rate’ we mean the proportion of the wider population of Mäori women smokers/recent quitters

(excluding those on Aukati Kai Paipa 2000) who at the time of the baseline survey were quit and had stopped smoking during the previous 12-month period. This latent quit rate measure is therefore useful for comparison with the 12-month point prevalence quit rate (rather than continuous quit rate) because for both the latent quit rate and the 12-month point prevalence quit rate those ‘currently quit’ may not have been quit for the whole 12-month period, but were quit at the time they were interviewed.

79 This latent quit rate is similar to that recorded among adult New Zealanders in two telephone surveys in 1996 and 1991 (Laugesen and McClellan 1999). In those surveys Mäori had similar latent quit rates over 12 months as non-Mäori (12%), but had a higher propensity to relapse. There are more details on this in Appendix E.


Comparisons were made between those surveyed in the baseline survey who were currently quit and those Mäori women smokers on the Aukati Kai Paipa 2000 programme who were quit at 12 months.

• Comparisons of the demographic profiles show that these two sub-groups differed in a number of areas as follows. Compared to those in the baseline those on the programme: – tended to be slightly older (98% were 20 years or over compared with 83%),

although both groups included a sizable proportion of smokers under 30 years old (24% and 40% respectively)

– were more likely to have a community services card (65% compared with 43%)

– were less likely to have a telephone (93% compared with 100%) – were more likely to be a student (11% compared with 18%), unemployed (6%

compared with 2%), or other beneficiaries (19% compared with 5%) – tended to live with more smokers (14% lived in households of three or more

smokers compared to 5%) – were more likely to have started smoking at a younger age. Most (89%)

started smoking prior to being 20 years old, compared to 56%. Given the older age profile and the fact that they started smoking at a younger age, it is not surprising that they tended to have been smoking for longer. Most (87%) had been smoking for 10 years or more, compared with 66%

– were more likely to have no partner (39% compared with 18%). Table 5: Profile of Mäori females on the programme who were quit at the 12-month follow-up

compared to baseline respondents who were currently quit

Aukati Kai Paipa female Mäori participants quit at 12 months

%

Baseline currently quit

%

Gender1 n=280 n=168

Wahine (female) 100% 100%

Tane (male) – –

Total 100% 100%

Ethnicity1 n=283 n=168

Mäori 100% 100%

NZ European/Päkehä 11 2 35

Other European 3 2

Samoan 1 1

Cook Island Mäori 0 1

Tongan 0 1

Niuean 0 1

Other ethnicity 1 1

Total 116% 3 142% 3



%


%

Age n=266 n=168

Under 20 2% 2 17%

20–30 21 23

31–40 35 23

41–50 24 18

51–60 13 10

61–70 4 7

71–80 1 1

91+ 0 0

Total 100% 100%

Household size n=277 n=168

One 7% 4%

Two 17 21

Three 18 23

Four 20 20

Five 16 16

Six 11 7

More than six 12 10

Total 100% 100%

Community services card n=247 n=168

Yes 65% 2 43%

No 34 56

Don’t know 1 1

Total 100% 100%

Phone ownership n=280 n=168

Yes 93% 2 100%

No 8 0

Total 100% 100%

Employment status n=263 n=168

Self-employed 8% 7%

Full time salary or wage-earner 32 26

Part time salary/wage-earner (less than 30 hours/week)

18 21

Retired 3 7

Full-time homemaker 11 14

Student 11 4 18

Unemployed 6 4 2

Other beneficiary 19 2 5

Total 108% 3 100%



%


%

Smokers in household (at 12 month follow-up)

n=257 n=168

None 43% 47%

One 28 35

Two 15 14

Three 6 5 2

Four 2 2

Five 3 1

Six 1 0

More than six 2 0

Total 100% 100%

Age started smoking n=279 n=168

Under 15 41% 4 28%

15–19 years 48 2 28

20–29 years 10 50

30–39 years 1 19

Over 40 years 0 2

Don’t know 0 2

Total 100% 100%

Years as a regular smoker n=280 n=168

Less than 10 years 13% 2 34%

10–19 years 31 26

20–29 years 32 22

30–39 years 17 10

40–49 years 5 7

50–59 years 1 1

60 or more years 0 1

Don’t know 0 1

Total 100% 100%

Partner’s smoking status (at 12-month follow-up)

n=140 n=168

Have no partner 39% 2 18%

They’ve never smoked regularly 15 29

They’re a past smoker 19 26

They’re a current smoker 28 26

Total 100% 100%

Note: Components may not always add to 100% exactly because of rounding. 1 These profiles include only Mäori women. The baseline survey only included this group. For Aukati Kai Paipa this

group were selected out for this profile. 2 p<0.0001 3 Total exceeds 100% because of multiple response. 4 p<0.005 5 14% had three or more smokers in the household compared to 5%.


5.7.2 Comparisons with other cessation programmes There are few comparisons that can currently be made with Aukati Kai Paipa 2000, due to the lack of longer-term data for other smoking cessation programmes that provide Nicotine Replacement Therapy and counselling (ie, the same type of intervention as Aukati Kai Paipa 2000). Furthermore, information on the effectiveness of programmes for Mäori clients is currently very limited. The following two New Zealand programmes do provide Nicotine Replacement Therapy and counselling. However, data is not available at this time to allow particularly useful comparison with Aukati Kai Paipa 2000.

1. The Smokescreen programme is a mainstream cessation programme provided by GPs and Hospitals (Woodward and Laugesen 2000).

This service provided Nicotine Replacement Therapy to 347 people in primary care (ie, through GP clinics and medical centres) and 560 people in secondary care (ie, in hospitals). The GP clinics that took part were all in the Pegasus Independent Practitioners Association (IPA) Medical Group in Christchurch. This programme is not a Mäori-specific service and has no special cultural components.

The data for the group of participants most like Aukati Kai Paipa 2000 participants (ie, those treated through primary care (GP clinics) rather than secondary health care), includes both Mäori and non-Mäori, and the quit rate reported is probably depressed somewhat by the low response rate.80 • Smokescreen programme had a 10% point prevalence quit rate at six months. • Aukati Kai Paipa 2000 point prevalence quit rate is 32% at six months (using a

comparable definition for quit).81

2. The New Zealand Quitline Subsidised NRT programme provides support and advice via the telephone and paper materials, and Nicotine Replacement Therapy via exchange cards taken to a pharmacy for patches or gum. The service is accessed by both Mäori and non-Mäori smokers.

At the time of writing, the Ministry of Health had commissioned an evaluation of this programme that will provide quit rate data for Mäori programme users as well as all programme users, six months and 12 months after they start on the programme. The findings will be available in 2003.

Activities for Quitline Subsided NRT programme evaluation included a three-month follow-up telephone survey of n=402 programme users (BRC Marketing & Social Research 2002). This survey provided early, indicative information about this programme. However, comparability with Aukati Kai Paipa 2000 data is limited as the findings are for a combined Mäori and non-Mäori sample of programme users.

80 The response rate for the Smokescreen six-month follow-up was relatively low (only about 50% of participants were

followed up). As non-respondents were counted as ‘not quit’, the quit rate of 10% may have been affected by the lower response rate (ie, the true quit rate may be higher).

81 The definition used in Aukati Kai Paipa 2000 is more conservative than that used in the Smokescreen evaluation, as those on Aukati Kai Paipa 2000 who had ‘occasional puffs’ and were currently not smoking were counted as ‘not quit’ (thus a comparative six-month quit rate for Aukati Kai Paipa 2000 would be somewhat more than 26% [32%]). See Appendix D for details.


• Quitline Subsided NRT programme had a 51% point prevalence quit rate at three months.82

• Aukati Kai Paipa 2000 point prevalence quit rate is 39% at three months (using a comparable definition for quit).83

Information about one other smoking cessation programme specifically for Mäori smokers is available. However, this programme does not provide Nicotine Replacement Therapy and the evaluation had some limitations relating mainly to the small number of clients monitored.

3. The Noho Marae programme provided a quit programme in a Mäori setting. This programme requires participants to attend a five-to-seven-day residential hui on a marae where they stop smoking on the first day of the hui. No Nicotine Replacement Therapy or other pharmacotherapies are used in the Noho Marae programme.

An evaluation following 26 people (Glover 1999) showed a point prevalence quit rate as follows.

• Noho Marae programme achieved a 35% point prevalence quit rate at four months.84 Note that these data are limited due to sample size and because the population is highly selected, as it includes only those who are able to attend the residential programme.

82 Note that ‘quit’ were those who had not smoked for two days. 83 The definition used in Aukati Kai Paipa 2000 is more conservative than that used in the Smokescreen evaluation as

those on Aukati Kai Paipa 2000 who had ‘occasional puffs’ and were currently not smoking were counted as ‘not quit’ (thus a comparative six-month quit rate for Aukati Kai Paipa 2000 would be somewhat more than 26% [32%]). See Appendix D for details.

84 This quit rate measure is similar to the Aukati Kai Paipa 2000 measure. Note that all (100%) participants were followed up for the four-month follow-up quit rate measure (so there is no missing data to consider). However it is a four-month quit rate, not six-month or 12-month quit rate and the definition of ‘quit’ is described as a self-assessed measure in that participants’ perception of whether they felt they were quit, so that even if participants had a few slip-ups (recently or not so recently) they were counted as ‘quit’ for this quit rate.


6 Discussion In this section we discuss the findings of this research in relation to 12 topics: 1. The quit rate achieved (and comparisons with previous research). 2. Use of the self-reported quit measure. 3. Reliability and validity of the data. 4. Impact of other tobacco control activities. 5. Access and elimination of barriers to access. 6. Seeking support for quit attempts. 7. Judgements about the helpfulness of the programme. 8. Efficacy of Nicotine Replacement Therapy. 9. Efficacy of quitting together with close whänau. 10. Impact on levels of second-hand smoke. 11. Possible extension of the programme. 12. Relative value of this type of programme.

6.1 The quit rate achieved indicates that the programme is a success

The quit rate achieved by Aukati Kai Paipa 2000 is significantly higher than the quit rate recorded for Mäori women smokers in the baseline research carried out as a part of the evaluation. Furthermore, given the characteristics of participants in this programme, the achievement of a 23% quit rate at 12 months should be seen as especially successful. International research has shown that age (older), higher education, socioeconomic status (higher), nicotine dependence/tobacco consumption (lower) and living with a non-smoking spouse/cohabitant are each well known determinants of success in smoking cessation (ie, higher quit rates), in the population in general as well as those using cessation programmes (Monso et al 2001; Osler and Prescot 1998). Participants on Aukati Kai Paipa 2000 tend to have many pre-existing characteristics that correlate to low success in smoking cessation.

• Tobacco dependence – participants smoked a median of 15 cigarettes a day at the time they started on the programme. Three quarters (76%) smoked more than 10 cigarettes a day. A quarter smoked 20–30 cigarettes a day (equivalent to ‘a pack a day’) (25%), whilst a further 11% smoked 31 or more cigarettes a day. Most (89%) had started smoking before they were 20 years old, and most (85%) had been smoking for more than 10 years.

• Cohabiting with smokers – nearly two-thirds (59%) lived with other smokers. Four in ten (41%) had a partner who was a current smoker (they may not have lived with this person).

• Lower socioeconomic status – one-third (38%) lived with four or more others, half (48%) were unwaged, two-thirds (65%) had a community services card, 10% had no telephone.


• Age – one-quarter (25%) were 30 years old or under, although very few (6%) were under 20 years old.

• Education – a small proportion (10%) had no high school education. Higher initial smoking levels predict lower quit rates (Monso et al 2001; Osler and Prescot 1998). Overall, the smokers on the programme were heavier smokers than Mäori smokers in the New Zealand population; 76% of participants smoked more than 10 cigarettes a day, compared with 53% for all Mäori smokers aged 15 years and over and 60% of all smokers aged 15 years and over (Ministry of Health 1999b). In addition to this data, the comparisons of the profiles of the respondents in the baseline survey who were currently quit and those Mäori women smokers on the Aukati Kai Paipa 2000 programme who were quit at the 12-month follow-up, also suggest that this programme was a success. The key comparison measure used for this evaluation was the measure of the latent quit rate for Mäori women smokers as estimated through the baseline survey. The above points, together with comparisons between those in the baseline and those on this programme, suggest that the latent quit rate may be an overestimate. For a population of smokers more like the participants on Aukati Kai Paipa 2000 (ie, with a lower socioeconomic status, etc) the latent quit rate could be lower than 12.5% at 12 months.

6.1.1 Comparison of quit rate data Making comparisons between the outcomes of different smoking cessation programmes should be done with caution (eg, when comparing quit rates). To ensure that valid comparisons are made, consideration ought to be given to the methodologies used in the research and the definitions used for quit and not quit (definitions can vary in significant ways). For some comparisons, given the definitions or research methodology used, it may be appropriate to recalculate the quit rates reported for this evaluation prior to making the comparison. See Appendices A and D (Table 73) for further details of data from Aukati Kai Paipa 2000 that are best used for comparison with other New Zealand smoking cessation programmes such as Quitline. In making comparisons it is also valuable to consider whether it is appropriate to expect similar outcomes for different programmes, as different programmes may provide their services to markedly different populations or provide markedly different interventions.


6.2 Self-reported quit measure is an appropriate and reliable measure for this evaluation

The quit rate measures used in this evaluation are based on self-reported quit status.85 Self-report measures tend to be considered inferior to measures that include verification (eg, using carbon monoxide or cotinine testing) as respondents tend to give socially desirable responses to quit status questions such as indicating that they are quit when they are smoking. Even though the measures used in this evaluation depend on self-report, the quit rates reported do provide good evidence of the success of this programme. We make this claim based on the following.

• The quit rate reported in this evaluation is a conservative measure of quit, as those who self-report that they are quit (ie, not smoked for two days), but who also indicate that they have occasional puffs, were counted as not quit. This has had the effect of depressing the proportion counted as quit to 23% at 12 months, down from 30%.

• Participants’ responses to questions about their quit status were probably affected by the social desirability phenomenon, although the impact of this may have been ameliorated somewhat for this programme. – Many quit coaches tended to have close social or whänau ties to the

participants such that they tended to know the participants’ quit status prior to questioning them, thus acting as a basic verification that is likely to have promoted accurate responding.

– The accuracy of participants’ responses was probably also enhanced by the fact that re-entry to the programme of support (ie, regular attendance at group or individual counselling sessions and/or further use of Nicotine Replacement Therapy) only occurred if they were open about the fact that they were still smoking.86

• International research (Murray et al 1993) suggests that 3–5% of those who indicate that they are quit through self-report may actually be smoking (that is, 3–5% indicated that they were quit were found to be smoking based on verification by cotinine or carbon monoxide testing).

• The quit rates achieved by the programme are far greater (between two to three times greater) than the latent quit rate for Mäori women.

Taken together these points suggest that even using this self-report method of measurement, the quit rates calculated can stand up to scrutiny and that this programme has had a real effect on decreasing smoking prevalence among Mäori women and their whänau.

85 See Appendix A, Section 7.3 for a commentary on the rationale for using this measure. 86 For this programme quit coaches tended to have difficulty ‘weaning’ participants off close support (attendance at

regular group or individual counselling sessions and use of Nicotine Replacement Therapy). Therefore, for many participants on the programme it was probably socially desirable to re-enter the programme through indicating their smoking status accurately.


6.3 Reliability and validity of evaluation data See Appendix A, Section 8 for a description of the data audits carried out by the evaluators and a detailed commentary on data reliability and validity. Appendix C describes the usage of data including decisions made to exclude data that was incomplete. Start day data describing participants on the programme:

• Start day data was collected and recorded for all n=3000 plus participants (this included descriptive data that has provided full demographic and environmental profiles, health information, smoking/quitting history, smoking/addiction level, etc). This start day data was considered as reliable (complete and accurate) and valid in that it represented all participants.

Follow-up interview data for determining quit rates:

• There was a considerable amount of missing follow-up data from several of the seven providers.87 This data was due to be collected at the three follow-up interviews and provide quit status data, among other things. Whilst this was an unfortunate situation, the fact that there was start day data for all participants on the programme meant that the amount of missing data was known, and the reliability and validity of data that did exist could be assessed with some accuracy.88 Scrutiny of the missing data determined that although data from just four of the seven providers89 was able to be used to calculate the 12-month quit rate for the programme overall, the participants from these four providers were very similar to participants overall in terms of socioeconomic status, smoking levels and all other measures.

• Whilst there is probably a relationship between the ability of a provider to collect and record data accurately and to deliver an effective programme in terms of achieving a high quit rate, the level of this effect cannot be determined. Anecdotally, the evaluators were aware of differences across the seven providers in the way that they delivered their programmes, yet the biggest differences occurred between the four providers whose data was used to calculate the 12-month quit rate. This is perhaps borne out in the fact that the quit rates across these four providers varied from 14–34% quit. Extrapolation of data on quit status at 12 months of those spoken to strongly suggests that, had more quit status data been available from two of the providers excluded from the final analysis, they would have achieved quit rates at the higher end of the range achieved by the four providers whose data was included in this measure (ie, they would have achieved quit rates of 20–30%).90

87 See Appendices A and C for full details of the missing data and for an explanation of which data was used in analysis. 88 See Appendix A, Section 9 for details of the reliability and validity of data. 89 See Footnote 87. 90 Two of the three providers excluded from the 12-month quit rate calculation submitted 12-month data for 49% and

33% of their participants respectively (ie, data for some n=365 participants). Their data was excluded from analysis as they did not have data on 50% or more of the participants due to be followed up. The amount of data was sufficient, however, to be used for extrapolation purposes to estimate the success of the programme delivered by these providers. The third provider submitted just 2% of the 12-month data that was due in (ie, data from five participants). Clearly, this could not be used to estimate the success, or otherwise, of the programme delivered by this provider.


• Given that programme participants and the quit rates achieved by the four providers used to assess the effectiveness of this programme appear to be similar to the providers overall (or at least six of the seven), the quit rate data presented in this evaluation has a reasonable level of reliability and validity.

Data about the level of intervention:

• There was a significant amount of missing data (the amount of missing data cannot be determined) about the level of intervention received by individual participants (ie, the number of counselling sessions and Nicotine Replacement Therapy received).

• Analysis of this data was carried out on only two to three of the seven providers (those for whom anecdotal evidence and scrutiny of the databases suggested that data was the most complete). This data may not be reliable or valid and should be considered with caution. For this reason only basic data is reported and analysis is limited (eg, no analysis is done on the number or type of counselling contacts and correlation to quit rates).

6.4 Impact of other cessation/tobacco control activities on the outcome of this programme

No programme or intervention is delivered in complete isolation. In New Zealand during the time that the pilot programme was being delivered (mid-1999 to mid-2001) there were a number of ongoing tobacco control activities including several cessation programmes/ interventions (see Section 1.4 for details). Therefore, it is probable that these activities may have had some impact on the success of this programme. It is not possible to determine the extent of any such impact. Evidence does indicate, however, that the impact of Quitline, the main cessation programme available to participants at the time of the pilot programme, was probably quite limited. Although 10% of all participants had used Quitline prior to starting on Aukati Kai Paipa 2000, just 2% of all participants did this at a time when Quitline was able to provide access to nicotine patches or gum. Furthermore, only 1–4% of participants reported using other cessation products (patches or gum or other products), other cessation services (including Quitline) or forms of support whilst on Aukati Kai Paipa 2000.

6.5 Access and elimination of barriers to access Data indicates that the programme was effective in delivering Nicotine Replacement Therapy and counselling to Mäori women and their whänau including those who do not choose to, or may not be able to, access other cessation services.

• Generally, barriers to access to this programme appear to have been limited (eg, cost of the Nicotine Replacement Therapy products, access to counselling, cultural barriers), although some barriers may still exist.


– For some providers the delivery was a ‘venue style service’ so that barriers such as transport, time and waiting at the venue could still exist.

– Other providers were able to deliver a more mobile style of service which probably eliminated almost all barriers to access. This included visiting groups of participants at a neighbourhood house, meeting participants at their place of work/study or, for housebound participants, providing counselling via the telephone (with occasional sessions in person) and delivering nicotine patches or gum via a mobile health worker (eg, kaiawhina, diabetes health nurse).

• Mäori with limited financial resources were able to access this programme (eg, half were unwaged). This is important considering that the $10 per month charge typical for patches and gum from most other cessation programmes (or the $100 plus charge per month for unsubsidised cessation products) could be a strong disincentive for this group. In fact, Mäori women quitters in the baseline survey (women not on this programme) did report that free cessation products and free access to health services would have made their last attempt much easier.

6.6 Empowering participants to seek support for their quit attempt

The programme was successful in encouraging participants to seek out and gain support for their attempt to quit smoking from their whänau and friends. Given that many participants lived with smokers, and tended to mix socially with smokers, the ability of programme providers to empower participants in this way was likely to have had a positive impact on the success of this programme.

6.7 Participants’ judgement of the helpfulness of the programme

Almost all participants (90–98% at different follow-up interviews) reported that the programme was much more helpful or a bit more helpful than other options. Participants’ lack of experience of other cessation aids and programmes could suggest that they did not have enough experience to make a valid judgement about the helpfulness of the Aukati Kai Paipa 2000 programme. However, evidence does indicate that the participants could make a valid judgement.

• Most participants had either tried to cut down (45%) or stop smoking completely (41%) prior to starting on the programme. Even if they had used a ‘cold turkey’ approach in the past they would know whether or not the method they used had been as helpful for them as the programme was.

• Mäori women quitters in the baseline survey (women not on this programme) typically reported using less formal methods of quitting for their last quit attempt such as getting support from friends and colleagues, cutting back, drinking water or doing exercise. Indeed, one-quarter used nothing to help them quit, suggesting that this is a common experience for Mäori smokers trying to quit.


• Whilst a significant proportion of participants had no prior experience of using cessation products or specific cessation services (between two-thirds and a half of respondents at each follow-up interview reported never having used these prior to starting on this programme), those who had experience of these reported similar levels of helpfulness as participants overall (95–97% for different follow-up interviews), albeit they were slightly less likely to indicate that this programme was much more helpful than other options.

Taken together, this data indicates that participants were able to make a valid judgement about the helpfulness of the programme even without prior experience of formal programmes or cessation products.

6.8 Efficacy of Nicotine Replacement Therapy Although those who used Nicotine Replacement Therapy were only slightly more likely to quit91 than those that did not use these products, this may have been due to the large proportion of participants who received more or less Nicotine Replacement Therapy than the recommended eight weeks (National Advisory Committee on Health and Disability 1999).

• Just over one in 10 participants (12%), for whom prescription data was recorded, received a start day dose of one week of Nicotine Replacement Therapy followed by receiving follow-up doses seven or eight times. This equates to eight to nine weeks of Nicotine Replacement Therapy.

• Those participants who received approximately eight weeks of Nicotine Replacement Therapy were much more successful in their quit attempt than other participants (35% quit compared to quit rates of 27–20% quit for other doses, or none at all 18% quit). Those who received nine to 15 weeks of Nicotine Replacement Therapy (probably over two distinct quit attempts)92 were also more successful (27% quit) than those who used no Nicotine Replacement Therapy (18% quit).

• This data concurs with the recommendations in New Zealand’s Guidelines on Smoking Cessation that a course of eight weeks of Nicotine Replacement Therapy is optimal (National Advisory Committee on Health and Disability 1999).

Note that differences in the efficacy of the two nicotine delivery mechanisms (patches and gum) could not be determined from this evaluation. This is due to the fact that fewer participants used gum compared to patches on this programme (52% compared with 83% of all participants), and almost all of those who used gum also used patches (47% of all participants).

91 That is, there was a significant difference at the 90% confidence interval, and not at the more standard 95%

confidence interval. 92 According to anecdotal information gathered during discussions with programme providers.


6.9 Efficacy of attempts to quit with close whänau The programme was effective in recruiting participants’ whänau onto the programme, including those living in the same household as participants. Whilst there had been some expectation prior to this evaluation that participants who joined the programme with whänau from their own household may experience greater cessation success (ie, a higher quit rate at 12 months) than other participants, this did not occur. It is possible that any positive impact on cessation success of attempting to quit with another person in the household was eliminated by the negative impact of co-habitation with other smokers or by having a partner who was a current smoker. These two factors (co-habitation and partners’ smoking status) were shown by this evaluation to be correlated with lower cessation success. Providers’ ability to attract whänau of participants onto the programmes probably should be encouraged and considered a success as it is unlikely to have significant negative impacts and over time may well have the desired positive impact of slowly decreasing the number of smokers in Mäori households. This outcome is important, because as more members of a household become smokefree, the stronger the environmental support for those attempting to quit smoking, which ought to lead to a snowball effect of rapidly decreasing the number of smokers in these households.

6.10 Impact on levels of second-hand smoke New Zealand research indicates that typically there are high levels of exposure to second-hand smoke among Mäori adults and Mäori children and poor health consequences of this exposure, such as the exacerbation of asthma and increase in chest infections (Osler and Prescot 1998). The fact that many participants (one-quarter to one-third) reported making changes to their living environments (their house, their car, etc) in terms of changing to a smokefree environment, and the fact that some households had no regular smokers in them by the end of the 12-month period (overall 26% had no current smokers, with 51% of participants quit at 12 months having households with no current smokers) is likely to have valuable flow-on effects for people in participants’ households and other close whänau (such as their mokopuna93).

93 Grandchildren.


6.11 Issues to take into account in a possible extension In carefully planning for a possible extension of Aukati Kai Paipa 2000, there are a number of issues that need to be considered further.

• The availability of experienced Mäori providers. Providers ideally need an existing client base to enable the programme to be implemented.

• A programme of planned workforce development. There needs to be a triple focus – first on pilot providers who may wish to extend their contracts, secondly on existing Mäori health providers who may want to add Aukati Kai Paipa 2000 to their service-base, and thirdly the development of new Mäori providers established specifically to run Aukati Kai Paipa 2000. (See the earlier process focused report for details on Mäori provider and Mäori quit coach training needs [BRC Marketing & Social Research and Te Pümanawa Hauora 2001].)

• Quality control through ongoing co-ordination will be important to the success of an extension of the programme nationally: – to monitor whether health workers’/quit coaches’ training and support is

adequate and to identify gaps in training and support – to maintain quality in a large-scale expansion of the programme regional co-

ordinators may be needed to support small groups of providers in each region. Given the success of the whakawhänaungatanga approach in the pilot and the tuakana/teina concept used in training new quit coaches, consideration should be given to pairing up experienced providers with novice providers.

• Hapü Mäori women have not accessed the programme in large numbers, even though they were an intended target group. – Some thought will need to be given to how this group ought to be recruited, as

currently the pilot providers have not been successful in recruiting them. – Some pilot providers were concerned during the pilot period, and continue to

be concerned, about the use of Nicotine Replacement Therapy with hapü women. The care and support of hapü women on the programme, whether this should include Nicotine Replacement Therapy and whether formal protocols to include participants’ Lead Maternity Caregiver94 are required needs to be addressed to resolve this situation.

Furthermore, the decision to target this group for this type of cessation programme may need to be reconsidered – the outcome data shows that the programme has been more successful for those in their 30s and 40s, yet this group (hapü Mäori women) may be younger (in their 20s).

94 During pregnancy when a woman chooses her maternity caregiver or caregivers (a GP, a midwife and/or specialist),

one of these professionals is nominated as their ‘Lead Maternity Caregiver’. This person is mainly responsible for the woman’s care and makes all key decisions about the woman’s care (in consultation with the other caregivers, the woman and any supporters).


• Given that the New Zealand Guidelines to Smoking Cessation (National Advisory Committee on Health and Disability 1999) and the outcome data in this evaluation indicate that there is an optimal level of support in terms of length of time using Nicotine Replacement Therapy,95 further consideration needs to be given to setting up formal protocols to promote best practice in this area. Note that the evaluation data suggests that it may be effective to provide more than eight weeks of Nicotine Replacement Therapy for highly motivated participants making another quit attempt following relapse.

• Given that the effectiveness of Aukati Kai Paipa 2000 will continue to be of interest to funding agencies and others after the pilot period, adequate monitoring of participation rates and effectiveness (eg, quit rates) will need to be maintained. To be comparable (at least across the Aukati Kai Paipa 2000 programme) this monitoring would need to be standardised.

• There is a need for a governance structure to ensure the many issues raised here (such as development of formal protocols regarding hapü women and the length of Nicotine Replacement Therapy, standardisation of monitoring) are addressed in a uniform way that ensures ‘buy-in’ from all providers of the programme. To be effective this structure would (probably) need to be referred to in provider service contracts or in some type of memorandum of understanding between providers so that there is a level of obligation to work together and to follow agreed protocols.

• Resourcing of the programme needs to be adequate to ensure the success of the programme. For a more detailed discussion about resourcing, refer to the earlier process-focused evaluation report (BRC Marketing & Social Research and Te Pümanawa Hauora 2001). – Ideally the level of funding should not be tied solely to participant recruitment

numbers, as this tends to promote fast recruitment which can result in a low level of support for participants.

– Programme resourcing should allow for a core group of staff working out of one site (ie, three or four quit coaches and a co-ordinator/manager) (see Section 7.3 for details on the ideal quit coaching team).

– Programme resourcing should be available to enable quit coaching support of clients on an intensive and long-term basis and take into consideration the cultural obligations and accountabilities of a service delivered in a Mäori setting (see Section 7.3 for details on the ideal quit coaching team).

– Programme resourcing should provide for up to 12 weeks’ free Nicotine Replacement Therapy for each client (ie, eight weeks of Nicotine Replacement Therapy with the possibility of more following relapse, if motivation levels indicate it [see Sections 1.3.5 and 5.3.1 for details on length of the programme]).

95 Outcome data suggests that providing Nicotine Replacement Therapy for approximately eight to nine weeks is more

likely to correlate to a high quit rate compared to providing it for 16 or more weeks or for three to four weeks (or less).


– Programme resourcing will need to cover transport and telecommunications in order to provide increased access to both vehicles and cell phones relevant to staff need (see Sections 1.1 and 1.3 for details on how the programme is delivered).

– Programme resourcing should include provision for the development or purchase of culturally appropriate resources (see Sections 1.1 and 1.3 for details about delivering a programme that is appropriate for Mäori).

– Programme resourcing needs to consider the large administrative support role. (Some providers have had volunteers to do this work, however this is likely to be unsustainable.)

– Programme resourcing needs to consider the support role established providers have in assisting newer, less established providers to develop their programmes (ie, less established/experienced in terms of delivering this programme).

6.12 Relative value of this type of programme Relative to other tobacco control interventions, this programme (and the carrying out of a pilot phase) has some distinct advantages as well as disadvantages from a purchasing and efficacy perspective. Some advantages include that:

• the programme appears to reach a ‘hard-to-reach’ group who do not choose to access, or are unable to access, other cessation services

• this type of programme enhances access for those without telephones, and for those who have a preference for face-to-face services and for services that cater for the varied cultural needs of different populations of Mäori

• it has also been advantageous to carry out a distinct pilot phase of the programme and evaluation of this. Through evaluation this programme has been shown to utilise a model that could be followed for other culturally appropriate services (and the purchase of these) such as those aimed at managing diabetes, asthma, heart disease, or mental illness, etc.

Some disadvantages include that the nature of the programme (in being managed, adapted, and delivered locally in order to meet the needs of the local populations) means that it will always be relatively demanding in terms of national administration, initial and ongoing training, quality control and improvement, and monitoring of outcomes (including internal and external evaluation). When considering the cost of the programme two perspectives could be taken. Whilst some might consider this programme to be expensive to deliver compared to alternative smoking cessation programmes, any such judgement needs to be considered within the context of the broader impacts of the programme. Specifically, in considering the full ‘cost’ of the programme the impact of smoking prevalence and related health outcomes for Mäori ought to be considered (such as escalation/alleviation of related illnesses of smokers and their whänau, and overall health sector spending on smokers and their whänau).


So whilst the cost (eg, cost per quitter) may be comparably higher for this programme, the medium- to long-term costs of not tackling smoking prevalence in this population and the medium- to long-term savings of working on this issue probably far outweigh the programme costs.


7 Conclusions In this section, we present the following: • An overview of the findings. • A case for extending the programme. • Recommended programme provider.

7.1 Overview Aukati Kai Paipa 2000 has been successful and a planned extension of the programme is indicated.

• The programme is an effective channel for providing this intervention to the target group (Mäori women and their whänau) and has effective outcomes (high quit rates and changes in smoking-related behaviour).

• Even those who are heavier smokers, and those more highly addicted, are able to quit on this programme.

• The programme is acceptable to participants, it is accessible and culturally appropriate.

• This programme is also effective for some non-Mäori smokers and some male smokers who participated in the programme to support Mäori women who were their close whänau.

• The demographic profile (especially socioeconomic information) and the smoking/ quitting history of the participants (especially level of addiction to tobacco), together with the fact that participants do not tend to access other cessation services, suggest that this programme has been a success as it has reached and has been effective for a population that could have been expected to have a low quit rate.

• It will be important in any decision-making about Aukati Kai Paipa 2000’s relative cost-effectiveness to consider who the programme has reached, the lack of other services for this group and the fact that overall the evaluation does suggest that this programme would be a good use of health sector resources relative to health sector spending in general.

• Careful planning will be required in selecting suitable providers and supporting them adequately if the programme expansion is to be successful. Even some of the seven pilot providers, who were selected on the basis of having prior experience in smokefree or cessation and as having existing client management systems and a management infrastructure, experienced difficulties managing client data. Delivery was affected by the limited experience and excessive workloads of the quit coach staff and the co-ordinators/managers. These difficulties had a flow-on effect on data collection for the evaluation itself and may have had a negative impact on the quality of services delivered to participants.


7.2 Extending the programme In addition to the considerations outlined in Section 6.11, we make the following recommendations about the extension of this pilot programme.

1. The programme be extended to include regions of high need (ie, high Mäori populations, high smoking prevalence).

• There is significant need right across New Zealand for this service. There are a number of regions of high need that have not been a part of the pilot. However, given the current phase of Mäori provider development,96 and the significant and varied needs of their clients, further extension of the programme would need careful planning to provide for the additional needs of Mäori providers, such as support and training, to ensure successful, sustainable and effective implementation of the programme (many of these needs are mentioned in Section 6.11 and later in this section).

2. The programme is provided in a holistic Mäori health service setting, by a Mäori smokefree workforce (ideally this would include a smokefree management or one that is committed to moving towards being smokefree).

• Mäori are best able to work with Mäori clients (see Section 1.3).

• Quit coaches should be Mäori and non-smokers who live and work in the communities in which they are delivering the programme.

• Health providers delivering the service should be within a holistic health and social service setting, and have networks with these other services to ensure that they can provide for all their clients’ social and health needs (see section below for details on the ideal provider and ideal quit coach team).

Mäori health providers. Person must be culturally sensitive, conscious of tikanga. Aukati participant

Services should be provided ‘for Mäori’ in a Mäori health setting which is casual and relaxed. Aukati participant

People who have tikanga and ex-smokers with empathy. Aukati participant

It needs to stay in the hands of Mäori ... with the freedom to provide what seems appropriate for them. Quit coach

3. Maintaining diversity will be important to the success of an extension of the programme.

• Purchase the programme in diverse Mäori communities (see Section 1.3.2 for commentary on diverse Mäori communities).

• Enable and encourage providers to adapt service delivery to suit the needs of their local Mäori communities and client bases.

96 Mäori health providers are in a relatively early stage of development.


4. Intensive and long-term support of clients should be a part of the service.

• The programme requires intensive, long-term support of participants. Resourcing should allow for regular, weekly contact initially for eight weeks, then irregular (fortnightly/monthly) contact for up to 12 months (see Sections 1.1.7 and 1.3.5 for details on the length of the programme).

• Further consideration of how intense the longer-term (eg, after three months) support should be. Data presented here is inconclusive, but it is possible that intense, long-term support (three months to 12 or more months) may correlate with a low quit rate due to dependence on quit coaches.97

5. Nicotine Replacement Therapy should be a part of the service.

• Nicotine Replacement Therapy should be provided free of charge to ensure that those most in need are able to access the service.

• Provide at least eight weeks of Nicotine Replacement Therapy (patches and gum), preferably 12 weeks to allow for high levels of nicotine addiction and for relapses. Further consideration should be given to determine in what situations eight to 12 weeks of Nicotine Replacement Therapy is appropriate and whether more than 12 weeks is ever advisable.

6. It may be most effective to target certain groups of potential participants. Success with some participants (those who are younger or who have not tried to stop smoking before) may be achieved through a different type of intervention. Outcome data showing quit status at 12 months suggests that the programme may be more effective for those who can be described in the following way:

• Age – anyone over 20 years old was likely to quit, but those over 30 years old were possibly more likely to quit.

• Those who had previously tried to stop smoking completely or cut down are more likely to quit than those who had not.

• Having a partner who was a past smoker (perhaps because of the ‘expert’ support received) appeared to promote quitting.

• Changing the smoking habits of the whole household, so that there are fewer smokers in the house at 12 months, appeared to promote quitting.

Given these recommendations and those throughout the report, a list of key points to include in service specifications was developed. It was presented in an earlier report on evaluation of this programme (BRC Marketing & Social Research and Te Pümanawa Hauora 2001).

97 By ‘intense long-term support’ we are referring to very frequent personal support (weekly or fortnightly) over the

longer term (eg, for three months to 12 months after start day). These sessions are characterised by their counselling nature. In contrast, less intense support could be described as occasional contacts which occur monthly (or less frequently) over the longer term. This contact would be characterised as a brief ‘check-in’ on quit status to monitor potential for relapse.


7.3 Recommended programme provider The seven pilot providers were all successful in adapting the programme plan and implementing a programme to meet the needs of local Mäori. However, across the seven pilot providers there were differences in the success experienced and in their ability to record that success. Difficulties affecting the implementation of the programme included staffing problems (lack of experienced smokefree staff, staff turnover), high workload, poor client information management processes, etc. Many of these difficulties were indicative of the early phase of Mäori provider development (such as undeveloped management structures and less mature management processes) and the limited nature of the Mäori workforce capacity which affects both individual staffing and organisational performance. During the course of the pilot programme and the evaluation a number of issues arose which clearly indicated the characteristics of an ideal provider and the ideal quit coach teams. In summary, the ideal provider for Aukati Kai Paipa 2000 can be described in the following way:

• Be a Mäori health provider (with a Mäori client base, providing a culturally-safe service consistent with Mäori culture and values, having a supportive environment for both Mäori employees and clients and that reflects cultural diversity).

• Provide a holistic Mäori health setting (based within a holistic health and social services setting, with networks with other Mäori-appropriate services and organisations). Note that all seven pilot providers were situated within a Mäori health service that provided other health services prior to Aukati Kai Paipa 2000 commencing.

• Have a smokefree approach (supports/promotes a smokefree environment, has a smokefree workforce).

• Provide managerial and administrative support for the programme (support to meet cultural obligations, practising smokefree policy, and having adequate administrative personnel and administrative systems).

• Have an existing and well functioning governance structure and health provider infrastructure in place to support the programme manager and staff (in terms of facilities, resources such as reception, and training, etc).

In summary, the ideal quit coach team needs to have a certain set of skills and attributes to allow them to work successfully in this complex, stressful role:

• be Mäori

• be smokefree

• be known in the community

• have prerequisite skills (such as nursing or similar social/health service background)

• have a wide range of skills and experience (see above)


• have a core team of at least three quit coaches plus a quit coach co-ordinator who work out of the same location (this is necessary to ensure a team of staff can work in a supportive, safe environment where staff are managed closely in a culturally appropriate way)

• have a quit coach co-ordinator who is full time (in order to provide adequate support and professional supervision).


References

BRC Marketing & Social Research, Te Pümanawa Hauora. 2000. Aukati Kai Paipa 2000 Evaluation Methodology & Implementation Plan. Wellington: BRC Marketing & Social Research.

BRC Marketing & Social Research, Te Pümanawa Hauora. 2001. Aukati Kai Paipa 2000 Evaluation Report Major Report #1. Wellington: BRC Marketing & Social Research.

BRC Marketing & Social Research. 2002. Quitline Subsidised Nicotine Replacement Therapy Programme Evaluation – 3 month follow-up survey. Wellington: BRC Marketing & Social Research.

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Appendix A: Evaluation of Aukati Kai Paipa 2000

1 Stakeholders of Aukati Kai Paipa 2000 The stakeholder groups for this evaluation include a broad range of people. Stakeholders are those who may be affected (directly or indirectly) by the evaluation of the programme and whose views about the programme have been sought. Representatives of most stakeholder groups were interviewed/surveyed about their perceptions of the pilot programme as a part of the evaluation – these are denoted by an asterisk. Members of other groups met the evaluators and their perceptions of the programme were discussed informally at smokefree conferences or at site visits or pilot programme hui. • Participants.* • Staff delivering the pilot programme (quit coaches).* • Managers of teams (team co-ordinator/manager).* • Managers/directors of the Mäori health services within which the pilot programme

situated.* • The trainer/co-ordinator.* • Ministry of Health/Health Funding Authority personnel.* • Mäori smokefree/cessation ‘experts’ (ATAK, etc). • Mäori communities. • Other Mäori health and social services. • Other (non-Mäori) health services. • Mäori health advocates.

2 Audiences for information about the evaluation The following are the audiences for the evaluation information. Note that information has been disseminated to audiences throughout the evaluation period using a variety of media. The evaluation report reflects a formal summary of all the information collected. Key audiences include: • Health Funding Authority/Ministry of Health • the Minister of Health and Associate Minister of Health • staff delivering the pilot programme (quit coaches) • managers of teams (team co-ordinator/manager) • the trainer/co-ordinator. Other audiences include: • participants • managers/directors of the Mäori health services within which the pilot programme is

situated • Mäori smokefree/cessation ‘experts’ • Mäori communities


• other Mäori health and social services • other (non-Mäori) health services • Mäori health advocates • smokefree sector (Quit Group, ATAK, smokefree and cessation workers, etc).

3 The evaluation team The evaluation was a joint venture between Te Pümanawa Hauora, based in Te Pütahi-ä-Toi, School of Mäori Studies at Massey University, Palmerston North (Te Pümanawa Hauora) – a Mäori Health Research Unit – and BRC Marketing & Social Research (BRC Research) – a Wellington-based mainstream research company specialising in market research/social research in the private and public sectors and in programme evaluation. The two partners shared the tasks with Te Pümanawa Hauora providing advice and expertise in the evaluation plan and methodological development, as well as advice and interpretation of all data analysis and research processes. They took a joint role in doing site visits and attending and presenting at hui. BRC Research provided input into the design of the evaluation plan and methodological development. They took on overall management of the evaluation, including managing many of the day-to-day tasks as well as the technical database support and data analysis and interpretation. They also took a joint role in site visits and in attending and presenting at hui.

4 The evaluation methodology Following the initial briefing by the HFA and consultation with key stakeholders, including members of the Advisory Group, the Health Funding Authority, PHARMAC and the pilot providers, the evaluation team developed the evaluation methodology. This was then independently reviewed, altered following the review, and then submitted to the HFA for approval. The HFA accepted the methodology as it was first submitted to them.

4.1 Consultation with key stakeholders by evaluation team The evaluation team carried out consultation with key stakeholders involved in the design of Aukati Kai Paipa 2000 to determine what these individuals saw as the key success factors of the programme, to understand what aspects of the programme the evaluation should focus upon, and to identify any areas that key stakeholders believed would be problematic either with the programme delivery or the evaluation itself. Those consulted with included members of the Advisory Group, the Health Funding Authority/Ministry of Health, PHARMAC and Te Hotu Manawa Mäori personnel.


4.2 The pilot providers’ role in data collection and maintenance A significant decision made by the steering group was to have the pilot providers collect, record and retain ownership of all data relating to participants in the programme. This decision was made for a number of reasons, including the desire to create the competency for data-handling within providers and to allow providers to adopt their own data policies consistent with the Code of Health Information and Mäori cultural wishes. While the rationale behind the decision was acknowledged, the decision caused concern to the evaluation team (and the peer reviewer of the evaluation methodology). It was felt that this approach would provide only limited control over the quality and integrity of the data. Unfortunately, all seven pilot providers did experience difficulties recording and maintaining the information electronically. As a result there was a significant amount of missing data at the three-month, six-month, and 12-month follow-ups (around half was missing). A decision was made by the evaluators, in consultation with the key stakeholders, to exclude data from some pilot providers from analysis – see Appendix C for further information.

4.3 The evaluation methodology The evaluation had process evaluation components (including formative feedback to pilot providers), in which the programme delivery was fully described, and outcome evaluation components, in which the programme outcomes were measured (quit rate, reduction in tobacco consumption and cost per quitter). The following key activities were completed, as per the methodology.

1. Consultation with key stakeholders.

2. An outcome evaluation (collection of data from all participants98 at start day, three-month, six-month and 12-month follow-up interviews, in-depth interviews with clients at one site).

3. A cross-site comparative evaluation involving all pilot providers (site visits, description of programme, review of programme materials).

4. A process and economic evaluation at one pilot provider (site visits, review of programme materials, description of programme, focus group with quit coaches, diary to record quit coaches’ time, collection of financial information).

5. An evaluation of the training and support provided to pilot providers (interviews with trainers and quit coaches, surveys of quit coaches, review of training materials, etc).

6. A baseline survey of the latent quit rate among motivated Mäori women not on Aukati Kai Paipa 2000.

Table 1 shows the specific evaluation activities completed in relation to each evaluation objective.

98 Attempts were made to collect data from all participants at these points (ie, sampling was not used).


5 Information sources and information collection methodologies

5.1 Information collection (questionnaires and interview guides) Information was collected using a number of methods, including the following.

1. Participants’ interviews/questionnaires. There were four separate questionnaires completed on start day (assessment for going onto the programme) and at follow-up three months, six months, and 12 months after starting the programme.

• For start day quit coaches assessed potential participants’ motivation level and readiness to quit in a one-on-one or group interview. Data collected included contact details, personal demographic profile (age, gender, ethnicity, education, employment, community services card holder status, whether they had ever had children), household profile (household size, children in household, whether others in the house were on the programme, telephone ownership) health data (pregnant/breastfeeding, asthma, cardiovascular disease, high blood pressure), smoking profile (addiction level, age started smoking, years smoking), smoking environment (smokefree status of house/car/workplace, smokefree status of those they live/mix/work with, partner’s smoking status, number of current smokers in household), quitting profile (prior quit attempts, length of most recent quit attempt, reason for past relapses, reason for quitting now, confidence in quitting), prescription of Nicotine Replacement Therapy, prior to the use of Nicotine Replacement Therapy and cessation services (such as Quitline or GP), how they accessed Aukati Kai Paipa 2000 (eg, via a referral, self-referral, etc).

• The follow-up questionnaires at three months, six months and 12 months were generally completed by quit coaches (or their assistants) by interviewing participants by telephone or in person. Data collected included perception of the service received, suggested improvements to the service, level of support from whänau, use of other products and services, quitting/smoking profile (quit status, length of time quit, tobacco consumption, addiction level, confidence in staying quit/quitting). At 12 months, additional data was collected to record smoking environment (smokefree status of house/car/workplace, smokefree status of those they live/mix/work with, partner’s smoking status, number of current smokers in household) and perceived health changes.

• In addition, a small number of participants at one pilot provider were interviewed directly by Mäori evaluators to assess their perceptions of the programme.

2. Prescriptions and contacts. Data on the number and type of Nicotine Replacement Therapy prescriptions and number and type of contacts with quit coaches was also recorded for each participant by pilot providers.

3. Quit coach interviews/questionnaires. Self-completion questionnaires were sent to quit coaches to collect their perceptions of the training and support received from the trainer/co-ordinator for the programme.


‘Exit interviews’ were carried out by Mäori evaluators with most quit coaches who left their role with the pilot programme.

4. Observational information and interviews. Information was collected during pilot provider visits (at least two per provider) and at regional management hui and national hui.

5. Interviews with stakeholders. Formal interviews and many informal conversations occurred with stakeholders, including the trainer/co-ordinator, the contracted trainer, Health Funding Authority personnel.

6 Details of definitions

6.1 Definitions used A number of definitions were developed by the evaluation team, as follows.

1. Participants who are ‘on the programme’ are those who: • have been assessed (ie, an assessment interview had been completed with them) • were identified as motivated during the interview (ie, ‘unsure – in the

contemplation stage’ or ‘ready – in the action stage’) – those identified as ‘not ready in the pre-contemplation stage’ were not counted as being on the programme even if they were assessed.

2. Participants who were ‘quit’ and ‘not quit’ at follow-up: • quit (not smoked for two days) and no occasional puffs = quit • quit (not smoked for two days) and occasional puffs = not quit • smoked in the past two days = not quit • no data (participant not interviewed at follow-up) = not quit.

Quit rate measure: The quit rate to determine the success of the Aukati Kai Paipa 2000 programme was the 12-month point prevalence quit rate.

number of people (n) quit at 12 months 12-month quit rate =

number of people (n) ever on the programme

6.2 Rationale for using a point prevalence quit rate measure A ‘point prevalence’ quit rate was selected for reporting the quit rate of Aukati Kai Paipa 2000 as it allowed some comparison with other programmes, including Quitline in both New Zealand and Australia. Measuring a ‘continuous’ quit rate is also common and is considered to be ‘best practice’ for measurement of the effectiveness of smoking cessation programmes. This aims to measure whether a respondent is quit continuously from their quit day to the day of follow-up. However, using a continuous quit rate measure was considered to be inappropriate for this evaluation for a number of reasons, as follows.


• For Aukati Kai Paipa 2000, the quit day was not a pre-set day (unlike laboratory-based studies of the effectiveness of Nicotine Replacement Therapy). Participants chose their quit day with assistance from their quit coach.

• For Aukati Kai Paipa 2000, all data from participants was collected by the quit coaches, not the researcher/evaluators, so there is only limited control over the quality of data collection methods.

• Investigations with the pilot providers indicated that independent verification of participants’ quit status (such as a carbon monoxide breathalyser or saliva tests) would not be appropriate for this pilot programme. In addition to cultural concerns of providing samples such as saliva, testing like this would imply distrust on the part of the quit coach. For both these reasons independent testing was considered to be counter to the relationship quit coaches built up with participants on the programme.

• Independent verification of participants’ quit status would require regular, random testing. This would have required resources far beyond those available for this pilot programme. Given the fact that the effectiveness of Nicotine Replacement Therapy and counselling as an intervention was not in question, this type of expenditure was not deemed to be appropriate.

In summary, the collection of a continuous or sustained quit rate would only ever be an approximation of those reported in the international literature because the data collection methods used in this pilot would not be as rigorous (ie, research reported in the international literature is typically carried out by the researchers themselves, not programme workers), quit status is measured from a pre-designated ‘quit day’ and quit status is confirmed using verification testing with carbon monoxide tests and saliva tests.

6.3 Rationale for using self-report Whilst typically there are concerns that self-reporting may lead to an erroneously inflated quit rate due to programme participants providing socially-acceptable responses (ie, indicating they are quit when they are actually smoking), this was not a particular concern for this programme. Self-reporting rather than independent testing was used for several reasons.

• The relationship built up between the participants and the quit coaches was a therapeutic one where it was in participants’ interests to say whether they had slipped up and returned to smoking as this opened access to further assistance to try to quit once more (eg, more Nicotine Replacement Therapy if appropriate).

• Many quit coaches tended to live within the same communities as the participants and tended to be aware of participants’ quit status (thus providing some verification).

• As described above, independent verification tests (such as a saliva test or carbon monoxide breathalyser) were considered to be inappropriate for Aukati Kai Paipa 2000.


6.4 Rationale for definition of ‘quit’ The definition of quit used in this evaluation and for the quit rate measure was ‘not smoked for two days’, and not had an ‘occasional puff’. This definition was similar, although not the same, as the definition used by the evaluators of Quitline Australia to allow simple comparisons between Aukati Kai Paipa 2000 and Quitline Australia, should they be required. To determine the point prevalence quit rate, the evaluators of Quitline Australia (Wakefield and Miller 1997; 1998) used the following definitions.

• A current smoker is a person who self-reported at index call (when first contacted the Quitline service) that they were ‘currently smoking’ (as opposed to quit in the last seven days),99 and who indicated at the two- to four-week follow-up that they were still stopped or a person who self-reported at index call (when first contacted the Quitline service) that they had quit in the last seven days and then indicated at the three-week follow-up that they had attempted to stop since last spoken to and were still stopped.

• At the six-month follow-up or 12-month follow-up a person who had stopped smoking at three weeks and was still stopped was either in the action phase (of the Stages of Change Model) or the maintenance phase, depending on how long they reported to have stopped smoking for. – Stopped smoking and in the action phase = not smoked for between 2 and 180

days (ie, two days up to six months). – Stopped smoking and in the maintenance phase = person not smoked for 180

days or more (ie, six months or more). Inclusion of those who are not current smokers but who have an ‘occasional puff’ as ‘not quit’:

• Those who had ‘occasional puffs’ were included as ‘not quit’ in the quit rate measure because the Mäori health providers delivering the programme collected and used this information to identify participants who were most likely to relapse (and thus to identify which participants were most likely to need more support and advice, for example, about avoiding relapse or to review the circumstances that triggered their urge to smoke).

• When stakeholders were consulted about excluding ‘occasional puffs’ in the quit rate calculation for the purposes of analysis and reporting on the success of Aukati Kai Paipa 2000 all stakeholders felt that the quit measure used to analyse the data should include occasional puffs as this best reflected the way that the programme was being run and in this way analysis would be most effective in assisting health providers to improve quality in service delivery.

99 Those who indicated at index call that they had quit more than seven days ago were not eligible to go onto the Cohort

of the Australian Quitline.


7 Comparability with other quit rates The quit rates achieved in Aukati Kai Paipa 2000 will, at various times, be compared to those achieved by other smoking cessation programmes. In making comparisons consideration needs to be given to:

• the comparability of the research methodologies (is the research based on one-off random surveys, a cohort survey or a census of all participants? is the survey period similar (ie, 12-month follow-ups)?)

• the comparability of key definitions such as ‘quit’, ‘not quit’, ‘quit rate’ and the base number used for the quit rate measure (are all persons in a cohort survey, or only those spoken to, included in the denominator of the quit rate measure?)

• the comparability of interventions (do they include Nicotine Replacement Therapy and counselling/advice or only one of these? is the intensity of the intervention (ie, whether counselling/advice is provided in a written format/telephone/face-to-face/ group sessions/individual sessions), and is the frequency and length of time that counselling support is provided, comparable?)

• the population the intervention reaches (do they include highly addicted or less addicted smokers? do they include smokers that research shows have characteristics that tend to correlate with high or low smoking cessation success?).

7.1 Comparing with Quitline programmes

7.1.1 Comparing methodologies

Quitline smoking cessation programmes100 provide a service to many people (there were some 200,000 users of Quitline New Zealand in the first year). The effectiveness of these services tends to be measured by either a single, randomised follow-up survey or a cohort survey (ie, where the same users are randomly selected for the first survey and are then followed-up at set intervals, with quit status being monitored at each follow-up).

• For a single random survey of users, the quit rate is calculated from responses of those spoken to in the survey. This method provides an estimate of the behaviour of all service users. The strength of the estimate depends upon the sample size and the standard error attached to the sample size.

• For a cohort survey, the quit rate is calculated using quit status at follow-up and by convention101 is based on all users interviewed at the first survey, including those not spoken to at follow-up.

Note that comparing quit rates from a cohort survey with those from single random follow-up survey may lend a slight advantage to the latter as the quit rate in the latter methodology includes only those spoken to.

Aukati Kai Paipa 2000 used a cohort survey of all participants (ie, ‘census’ of all users) rather than a cohort survey based on randomly-selected services users, as tends to be used

100 Such as those in New Zealand, Australia and Great Britain. 101 See Appendix A, Section 7.1.2, for commentary on Quitline Australia which diverges from this convention.


for research on Quitlines. Even with this methodological difference, the two approaches are essentially comparable. Therefore, the Aukati Kai Paipa 2000 quit rates will be comparable to the cohort survey for Quitline New Zealand, as well as other New Zealand smoking cessation programmes that use a cohort survey approach such as Quit For Our Kids. See Appendix A, Section 7.1.3, for further details. 7.1.2 Caution when comparing with Quitline Australia

The quit rates reported for Quitline Australia are based on a cohort survey, however they include only those users who were spoken to at each follow-up (Wakefield and Miller 1998). This has the effect of overestimating the effectiveness of Quitline Australia if one compares quit rates calculated from cohort surveys using the more conventional approach. That is, reports on quit rates for Quitline Australia do not tend to follow the common convention for cohort surveys of allocating those not contacted at follow-up as ‘not quit’. Those not spoken to at follow-up were ignored in the calculation for quit rate. See Appendix D, Table 64 for a recalculated quit rate for Aukati Kai Paipa 2000 which is comparable with Quitline Australia data. 7.1.3 Comparing quit definitions

The evaluation of Aukati Kai Paipa 2000 has reported two quit rate measures – one that is conservative (23% at 12 months) and a second less conservative quit rate (30% at 12 months). In terms of definitions, this latter quit rate measure of 30% at 12 months is similar to that used for reporting quit rates for many Australasian smoking cessation programmes (even if sometimes the methodologies are different – see notes above for more commentary). See Appendix D, Table 63 for a less conservative quit rate for Aukati Kai Paipa 2000 which will be comparable with Quitline New Zealand cohort survey data and Quit For Our Kids cohort survey data (both of which will be available in 2003).

8 Data validity and reliability

8.1 Data audits by the evaluators Data was regularly sent in by pilot providers for archiving by the evaluators and was audited to check for accuracy and completeness. Audits included re-entry (by the evaluators) of a small number of original paper records to compare the data with the electronic databases from pilot providers. Feedback was given to pilot providers on how to improve the quality of their data following audits.


Two or three data audits were carried out by the evaluation team for each provider to monitor data quality for both accuracy and completeness. These audits showed the following.

• Start day data. This was collected on each participant and appeared to be complete and accurate. Almost all participants who went on the pilot programme took part in the evaluation and start day data was collected from them.

• Contacts (number and type of counselling sessions, etc). Audits, to check whether the data that was on the electronic database was accurate and complete, were not always possible due to the way that data was stored on paper by some pilot providers. Most pilot providers attempted to record all contacts for every participant, but many reported difficulties especially for unplanned/incidental contacts or where the contact was a group contact. Some pilot providers also had problems transferring data from paper to the electronic database. This was mainly due to limited personnel resources or lack of experience with managing data.

• Prescriptions (number and type of prescriptions). Audits, to check whether data on the electronic database were accurate and complete, were not always possible due to the way that data was stored on paper by some pilot providers. All pilot providers attempted to record all prescriptions, although some pilot providers did not keep their electronic databases up to date, and some data could not be transferred to the electronic database when attempts were made to transfer all data from paper. The number of participants for which there was any data in the prescriptions database was only 62% of those thought to have received Nicotine Replacement Therapy (ie, they are recorded as having been prescribed Nicotine Replacement Therapy on start day, but they were not recorded in the prescriptions database as receiving further Nicotine Replacement Therapy). Site visits and detailed discussions with pilot provider staff indicate that almost all participants who started on Nicotine Replacement Therapy did tend to receive Nicotine Replacement Therapy for several weeks or more.

• Follow-up data (quit/smoking status). Audits showed that data that was on the electronic database was accurate and complete. All pilot providers attempted to collect their quit rate data completely and accurately, although from time to time several pilot providers missed collecting data due to limited personnel resources or poor process management. Pilot providers were encouraged not to follow up clients if they had missed the due date for follow-up by more than three weeks (so as to maintain the timeframe as planned). Most pilot providers got behind in transferring data from paper records to the electronic database at some point in the two-year evaluation period. This was due to both limited personnel resources and ongoing problems with hardware and software. Additionally, some pilot providers recorded quit rates as continuous quit rates rather than point prevalence (ie, they indicated a respondent was smoking if they had smoked at any time since their quit day). They were asked to record point prevalence quit rates (ie, whether the respondent was quit on the day their quit status was checked).


In conclusion, through the audits and inspection of the final data received from each pilot provider, we can say that:

• start day data was relatively complete and accurate

• contact and prescription data was incomplete and would allow only basic analysis. (We have therefore assumed that this data underestimates the number of contacts and the amount of Nicotine Replacement Therapy delivered by some pilot providers by an unknown amount.) Discussions with pilot providers (rather than formal audits) suggest that for three pilot providers the data may be reasonably complete, although this was not verified further

• follow-up data (quit/smoking status). There was significant amounts of follow-up data missing, more from some pilot providers than others. Importantly, the amount of missing data can be measured accurately as the number of participants on the programme with each pilot provider is known and the date that they started on the programme is also known.

See Appendix C for an explanation of the amount of missing follow-up data and what data was used in analysis.

8.2 Reliability and validity of the data In terms of reliability and validity, each source of data needs to be considered separately, given the differences identified through audits and inspection of the final databases received.

• Start day data can be considered as reliable (it is complete and accurate) and valid as it represents almost all participants.

• Contacts and prescription data is incomplete. The extent of the missing data cannot be determined and this differs across pilot providers. This data is probably not reliable and probably does not represent a valid description of the number and type of contacts or prescriptions delivered to participants on the programme – for at least four of the seven pilot providers. Any analysis of this data should be considered with caution and as indicative only.

• Follow-up data can be considered as reasonably reliable overall (it is accurate) for most pilot providers. For some pilot providers, however, the level of missing data is so high as to not be as reliable as for other pilot providers (due to incompleteness and consideration of non-response bias). Due to the missing data from some pilot providers, the follow-up data overall (amalgamating data from all seven pilot providers) could not be considered valid as it would not present an accurate picture of the success of the pilot programme as a whole. This is because all those participants for whom no follow-up data exists would be allocated as ‘not quit’.

To ensure that only the more reliable and valid follow-up data was used, a decision was made to use only follow-up data from those sites that had relatively complete data. See Appendix C for a full explanation of this.


• Overall comparisons across separate surveys. Even though data presented in this report represents data from all pilot providers at start day and only some pilot providers at follow-up, comparisons across separate surveys are reliable and valid.

The demographic/smoking behaviour profiles of participants for each survey are similar. There are very small differences in the profiles of participants at start day, six months and 12 months (differences are within 1% or 2%). See Appendix D Aukati Kai Paipa 2000 data (Tables 8–30).

9 Limitations of the evaluation This evaluation has been a qualified success. A great deal of information and data was collected by a sizeable team of evaluators and through the dedication of a large team of Mäori health workers and their administration staff. With every project of this size there are, of course, areas where more or better information could have been collected either through better design or better implementation.

9.1 Some limitations of this evaluation 1. Methodology, including the definitions used, meant that there are some limitations to

the evaluation – see Section 6 of this appendix for comments on the evaluation methodology.

The quit rate presented in this report is not comparable with other cessation services (such as Quitline), due to both the definition used as well as the methodology used. An adjusted quit rate calculated using a similar definition allows broad comparisons. (See commentary in Section 7 in this appendix for a full explanation.)

2. Data collected. Although data collection forms and processes were designed to allow detailed information to be collected for some data points, data available for analysis was incomplete or not useful for its intended purpose.

• Due to the unanticipated, intensive level of intervention delivered by quit coaches and the subsequent workload it entailed, data that described the intervention each participant received was incomplete (ie, contacts and prescription data). This limited what analysis was possible and meant that we recommend caution when interpreting this data.

• Some pilot providers did extremely well in collecting follow-up data (finding and interviewing over 70%, or even 90%, of participants). However, one pilot provider collected very little follow-up data (~10%) and others managed somewhat less than 50%.

• See Appendix C for details of missing follow-up data and discussion of what data was used in analysis.


3. Cost per quitter analysis. Procedures were successfully put in place to collect cost data at one pilot provider. However, cost per quitter analysis was thwarted because although financial information was collected, only about half the expected data (49%) for the 12-month follow-up was available from this pilot provider making the cost per quitter analysis limited and possibly not representative of Aukati Kai Paipa 2000 as a whole. There was also limited data available on the number and type of contacts and prescription. This meant that a cost per quitter analysis across different interventions was not possible.

9.2 Lessons learned 1. Data collection processes. For a number of reasons most data was collected directly

from participants by pilot providers and recorded on specially-designed electronic databases. There were numerous problems experienced with this, and by the end of the evaluation period it was agreed that most pilot providers did not have the skills and knowledge to do the data collection and data recording, especially at the same time. They were under significant pressure to design, implement and critique their pilot programme in situ.

Following this experience, we would encourage others to carefully consider who should collect data and who should record data electronically. If it is important, as it was in this case, for those delivering the service to own and manage their own data, consider whether these tasks could be shared or whether it is possible to delay giving the task to those delivering the service, at least whilst the service is in its initial implementation phase.

2. Recording the level of intervention. Further thought needs to go into how to effectively and efficiently record the level and type of intervention delivered to participants. This ought to include ascertaining whether it is necessary to record these details for all participants, or necessary at all. Given that the cost of collecting this data can be extremely high, it would be important that any data collected was both essential to an evaluation and that what was collected was complete and useful for thorough analysis.

3. Choosing case studies. Resources (in terms of time, personnel and budget) are always tight in large-scale evaluations. However, in evaluations of longer-term programmes the risks are too high to have only a single case study site. Always consider selecting two or even four case study sites where case study data is crucial to the evaluation.


Appendix B: Aukati Kai Paipa 2000 Model – in Detail The following table describes the stages of the Aukati Kai Paipa 2000 programme. It presents the key objectives and key activities of each stage, as carried out by the Mäori health providers delivering the pilot programme. Network/planning Timeframe: Dependent on whether networks are already in place

Key objectives Key actions

• Meetings to identify referral network

• Inform networks about the programme

• Develop referral protocols and procedures

• Develop consent protocols and procedures

• Develop protocols to work with ‘high need’ participants (hapü women)

• Develop storage and handling protocols for Nicotine Replacement Therapy

• Identify referral networks (eg, community-based health clinics etc)

• Make contact with networks

• Develop panui (flyers)/posters

• Develop referral process/referral forms

• Develop letters to GPs to obtain consent/consent forms for GPs to complete

• Identify appropriate (professional) support systems (eg, midwives, etc) to support ‘high need’ participants and develop agreements with these providers

Recruitment/promotion Timeframe: Ongoing


• Set criteria for participants in the programme (ie, motivated Mäori women and their whänau, hapü women)

• Recruit appropriate participants

• Raise awareness of programme

• Choose promotion methods

• Design promotion/recruitment materials (panui, posters, videos, tapes, flip charts, written press briefs)

• Arrange distribution and presentation of resources

• Plan procedures for dealing with the influx of enquiries

‘Preparation work’ with participants Timeframe: Up to three weeks with new participants


• Screen enquiries to identify those who are likely to be motivated quitters

• Inform participants about the programme and the changes they will go through

• Ensure participants have whänau support for when they quit

• Get participants to show their commitment/responsibility

• Prepare for quitting (to promote self-awareness of participants’ smoking habits, establishing some smokefree areas at home/ work, obtaining GP’s consent, etc)

• Set manageable goals with participants

• Describe the programme to participants

• Obtain GP’s consent for each participant

• Describe the criteria to participants (Mäori, hapü, motivated to quit)

• Describe requirements (eg, number of sessions)

• Inform about smoking and social history of tobacco and smoking among Mäori

• Inform about quitting, withdrawal and relapse

• Inform about Nicotine Replacement Therapy

• Preparation to quit, show commitment

• Get participants to go on a reduction programme

• Use multimedia

• Participants set up own support network


Assessment of motivation Timeframe: One session, before quit day (or around quit day), after preparation work is completed


• Identify stage participants are at (eg, ‘contemplation’, ‘action’, etc)

• Determine appropriate intervention (eg, Aukati Kai Paipa, a reduction programme or auahi kore programme)

• Determine whether to use Nicotine Replacement Therapy

• Check preparation work has been completed (ie, practised cold turkey, etc)

• Do assessment one-on-one (check health and smoking history, environmental influence)

• Record addiction level

• Review smoking pattern (eg, after work)

• Check doctor’s consent to go onto Aukati Kai Paipa

• Choose an appropriate intervention (eg, reducing or quitting, etc)

• Refer on if Aukati Kai Paipa is unsuitable

• Decide with participant dosage and type of Nicotine Replacement Therapy and when to use Nicotine Replacement Therapy

• Set up follow-up contacts with participants

Intensive programme – coaching Timeframe: From quit day to two to six weeks (dependent on smoking rate/addiction, and length of withdrawal period). Concurrent with ‘monitoring Nicotine Replacement Therapy’


• Setting a quit date

• Maintain regular contact, support by quit coach

• Monitoring Nicotine Replacement Therapy

• Dealing with withdrawal/overdose

• Support (peer support, checking in)

• Collect contact details, including an alternative address/phone

• Set up follow-up contacts with participants

• Meet individually to supply Nicotine Replacement Therapy and check for problems

Intensive programme – monitoring Nicotine Replacement Therapy Timeframe: From quit day to two to six weeks (dependent on smoking rate/addiction and extent of withdrawal period). Concurrent with ‘coaching’


• Determine and monitor dosage and reactions

• Determine whether to continue Nicotine Replacement Therapy usage if a bad reaction occurs

• Review dosage and review changes to dosage over time

• Start participants on Nicotine Replacement Therapy

• Review dosage of Nicotine Replacement Therapy with participant (confirm if want to use it)

• ‘Wean’ participants off Nicotine Replacement Therapy gradually


Maintenance and relapse prevention Timeframe: From three to six weeks after quit day to three months to six months after quit day


Part 1 (three to six weeks)

• Provide access to additional information on nutrition, exercise, health issues such as asthma, diabetes, etc

• Provide information and skills to maintain quit status

• Identify the relapse risk factors/events with each participant

• Teach participants to recognise these risk times/periods

• Teach behaviour modification to deal with urges to smoke and stressful periods

• Prepare an ‘emergency plan’ for each participant (eg, a ‘tangi plan’ [funeral plan])

Part 2 (6 weeks to 6 months)

• Acknowledge that relapse does happen and that participants need to prepare to prevent it

• Maintain intermittent contact to remind participants of support

• Monitor for relapse

Part 1 (three to six weeks)

• Provide group sessions to assist participants to identify likely stresses that could trigger relapse, to prepare ‘emergency plans’ and to teach skills (behaviour modification), basic nutrition and exercise information

• Refer participants to other services, if required

Part 2 (six weeks to six months)

• Irregular contact/opportunistic contact (perhaps as newsletters to clients)

• Planned contact (eg, six months)

• Set up groups of participants for mutual support

Dealing with relapse Timeframe: Required during relapse, flexibility is necessary


• Maintain contact to identify those who have relapsed

• Review current situation, reason for relapse, motivational status of participants to quit

• Ensure participants are aware of their triggers and reason for relapse

• Provide additional Nicotine Replacement Therapy (possibly for a shorter period, especially if smoking rate is lower than previously)

• Agree on how many times assistance will be provided (ie, for how many relapses coaching and Nicotine Replacement Therapy will be given)

• Maintain contact with all participants

• Reassess motivation, commitment

• Provide sessions to impart information, skills and support as required

• Consider Nicotine Replacement Therapy usage and provide as required

• Monitor Nicotine Replacement Therapy usage


Appendix C: Technical Information about the Data

1 Data analysis

1.1 Data available for analysis Almost all data from participants for the evaluation of Aukati Kai Paipa 2000 was collected and recorded by pilot providers. Due to inexperience in managing data collection activities and because of high workloads of quit coaches, not all data was collected and recorded on time (or sometimes at all). The missing data102 included the following:

• start day data – whilst each participant was assessed and information was collected about participants entering the programme, three pilot providers did not record all data into the electronic database system to pass on to the evaluators

• follow-up data – all pilot providers had missing data from the three follow-up interviews (which were due to happen for each participant three months, six months and 12 months after the start day of each participant).

The following table presents which data was available to the evaluators for analysis. Table 6: Data available for analysis (by pilot provider)

Proportion of data available for analysis by pilot provider

Total n

Total%

# 1 %

# 2 %

# 3 %

# 4 %

# 5 %

# 6 %

# 7 %

Start day* 3200 91 96 100 73 100 70 100 100

3 months expected** 3099 49 36 83 12 18 49 71 77

6 months expected 3024 47 34 76 8 32 39 81 73

12 months expected 2488 54 33 62 2 72 41 92 79

* Except for Site 3, pilot providers provided all of the start day data collected (ie, some fell short of their planned quota of clients) – the planned quota was for 3500+ clients in total in a little under two years of recruitment.

** Note this is the number of follow-ups expected given that n=3200 were recorded as recruited onto the programme, and given the date that they were recruited. Not all those recruited were due to have received a three-month follow-up by June 2001 as they had started the pilot programme after 1 April 2001.

1.2 Data used in analysis Given that there was a significant amount of missing data at the three-month, six-month, and 12-month follow-ups (around half was missing), a decision was made by the evaluators, in consultation with the key stakeholders (Health Funding Authority/Ministry of Health, the pilot providers and the trainer/co-ordinator), to exclude data if a high proportion of the expected data was missing.

102 Attempts were made to catch up on data entry by providers and also the evaluators (on behalf of providers).

However, by November 2001, some four months after the end of the pilot period, some data was still missing.


A decision was made to analyse data only where 50% or more of expected data103 was available to the evaluators. That is, data from a pilot provider was included only if 50% or more data was available from that pilot provider for that particular follow-up interview. The data shaded in grey in Table 6 was therefore not included in the analysis. This meant that the overall effectiveness of Aukati Kai Paipa 2000 (at 12 months) was determined by considering the quit/smoking status of participants at four pilot providers. At these four pilot providers the quit status of all participants was included in determining the quit rate (ie, those not found at 12-month follow-up at these four pilot providers were allocated as ‘not quit’ for the purposes of the quit rate measure). See Appendix A, Section 6 for further details of the quit rate measure. As a high proportion of data from all pilot providers collected on start day was available to the evaluators, all start day data collected was included when profiling participants demographically, in regard to their smoking/quitting history and with all other data collected at start day. Table 7: Data used in analysis

Data used for analysis Total n

Number of pilot providers data was from

Start day 3200 all 7

3 months expected 1099 3 of 7



2 Statistical tests of significance used on the data presented in this report

2.1 We chose to consider the sample as a small proportion of a very large population of potential users of the service

Typically when data is collected on a sample that is a large proportion of a finite population the standard error is somewhat less than for a random sample that is a very small proportion of a population. However, even if the sample is a relatively large proportion of the ‘apparent’ population (eg, almost all current users of a service), it can be useful to consider the sample as a small proportion of a very large population of potential users of the service.

103 By ‘expected data’, we are referring to the number of three-month, six-month or 12-month follow-up interviews due

to be carried out by June 2001, given the number of participants a pilot provider had on the programme (and had start day data for), and the date in which the participants started on the programme (eg, only those who started on the programme before 1 April 2001 were due to have a three-month follow-up by the end of June 2001).


With these more conservative (higher) estimates of sampling in place the data can provide insight into the potential future use of a service, its potential future users and its potential future effectiveness. In a situation such as this evaluation where programme expansion has been a strong possibility from the outset, it is appropriate to treat the sample data in this way (ie, as a small proportion of a very large population of potential users of the service).

2.2 Statistical tests of significance used on the samples Provided below are statistical tests of significance used to test the results presented in this report. In accordance with convention, the following tests for statistical significance have been based on the ‘95% confidence interval’. The 95% confidence interval is the range around the single survey-derived estimate that, were an infinite number of unique random samples drawn from the population of interest, we would expect 95% of the alternative estimates to fall into. 2.2.1 Margin of error for a simple random sample estimate – small sample

relative to population

The standard confidence interval formula is:

p ± 1.96 * sqrt[p(1-p)/n]

where: p = the proportion (%) of interest n = the sample size sqrt=square root

Survey n= p

(assumed) Standard error

Start day 3208 50% ± 1.7%

3-month follow-up 1099 50% ± 3.0%

6-month follow-up 1067 50% ± 3.0%

12-month follow-up 1400 50% ± 2.6%

2.3 Difference between two percentages (for dependent and independent sub-samples)

There are at least two types of comparisons that are likely to be made on the data presented in this report:

1. Comparisons of mutually exclusive groups like quit rate for different demographic groups or types of intervention (independent sub-samples).

2. Comparisons of cohorts of the same people re-interviewed such as participants’ responses across the start day and three follow-up surveys (dependent or correlated sub-samples).


2.3.1 Margin of error for the difference between proportions from independent sub-samples

For example, comparing quit rates for different demographic groups, within the same survey. The 95% confidence interval formula for comparing estimates from two independent simple random samples (ie, two mutually exclusive groups that have no overlap with each other) is:

|p1 – p2| ± 1.96 * sqrt[p1(1-p1)/n1 + p2(1-p2)/n2] where |….| denotes absolute value, ie, ignores sign

p1 = the proportion (%) of interest in sample 1 p2 = the proportion (%) of interest in sample 2 n1 = the size of sample 1 n2 = the size of sample 2 sqrt = square root

If this confidence interval does not cross zero, ie, the expression on the right hand side of the ‘±‘ sign is smaller than the difference between the two estimates (p1 and p2), then the difference is statistically significant.

Sub-samples n1= p1= n2= p2= Difference that is significant

Quit rate (Nicotine Replacement Therapy used/not used)

1244 24% 156 18% 11% or more

Quit rate (tried to quit before/not tried) 626 25% 219 17% 8% or more

Quit rate (conservative measure) at 12 months compared to the baseline survey

1400 23% 1337 12% 4% or more

Quit rate (similar measure) at 12 months compared to the baseline survey

1400 30% 1337 12% 4% or more

2.3.2 Margin of error for the difference between proportions from dependent or

correlated sub-samples

An example of dependent samples is comparing data between the assessment and the 12-month cohort survey, as the same people were surveyed in each. The 95% confidence interval formula for comparing proportions from two dependent samples is:

|p1 – p2| = 1.96 * sqrt [p1(1-p1)/n1 + p2 (1-p2)/n2 – 2(p12- p1p2)/n1] where |….| denotes absolute value, ie, ignores sign

p1 = the proportion (%) of interest in sample 1 p2 = the proportion (%) of interest in sample 2 n1 = the size of sample 1 n2 = the size of sample 2 p12 = the proportion (%) of interest in both samples, or ‘overlap’

proportion (eg, proportion quit in both samples) sqrt = square root


If this confidence interval does not cross zero, ie, the expression on the right hand side of the ‘±‘ sign is smaller than the difference between the two estimates (p1 and p2), then the difference is statistically significant.

Sub-samples n1= n2= p1= p2= p12 MOE Is difference significant?

Proportion that smoked over 20 cigarettes per day at 12 months and start day

3130 644 36% 6% 2% 2.5% Yes

Partners’ smoking status current smoker at 12 months and start day

2935 372 35% 41% 6.3% 4.3% Yes

Proportion of participants who mixed with mostly/totally auahi kore104 people at 12 months and start day

3006 1120 11% 20% 1.7% 2.6% Yes

Proportion of participants quit at 12 months who mixed with mostly/ totally auahi kore people at 12 months and start day

425 354 11% 28% 3.8% 5.4% Yes

Proportion of participants whose home was mostly/totally auahi kore people at 12 months and start day

2742 1108 42% 62% 12.6% 3.9% Yes

Proportion of participants whose car was mostly/totally auahi kore people at 12 months and start day

2532 1039 29% 60% 8.9% 4.6% Yes

104 Auahi kore is smokefree.


Appendix D: Aukati Kai Paipa 2000 Data Tables

1 About these tables

1.1 Reading these tables See Appendix A, Section 8 for discussion on the validity and reliability of the data. Care needs to be taken by reading the title of each table to determine whether the data presented is at start day (profile information) or is follow-up data (eg, six-month follow-up interview). Data presented in the tables is based on data recorded (rather than total sample). The total base number (n=) therefore varies slightly across the tables of data. Where a sub-sample of respondents was asked a question, this is indicated by the term ‘sub-sample’ in the table and a table footnote describes who was asked the question. Profile of the Aukati Kai Paipa 2000 participants

The first set of data (Tables 8 to 30 in Section 2 of this appendix) profiles participants on the programme. The tables describe the participants at start day (when they started on the programme). It presents these start day profiles for those followed up at six months and at 12 months.

• The profile of the 3000+ on the programme shows the broad range of Mäori women and whänau used the programme, in terms of both demographic profile, smoking histories, etc.

• These profiles clearly show that, although not all participants were followed up those followed up at six months and 12 months are representative of those who started on the programme.

Outcome of Aukati Kai Paipa

Section 5 of this appendix includes quit rates and a series of tables (especially Tables 44 to 62) that can be used to determine correlations between data items and quit rates (eg, correlations of age and quit rate or types of intervention). Broader quit rate measure

A broader quit rate measure has been calculated (Tables 63 and 64) that is the most suitable one to use in comparison with other smoking cessation programmes. See commentary presented in Appendix A for further details.


2 Profile of Aukati Kai Paipa participants

2.2.1 Demographic profile

Table 8: Age (start day)

Start day 6 months 12 months Q7 How old are you?

Total n=2994

%

Total n=980

%

Quit n=259

%

Not quitn=721

%

Total n=1305

%

Quit n=303

%

Not quitn=1002

%

Under 20 6 4 0 6 5 2 5

20–30 21 19 18 19 21 18 22

31–40 33 34 35 34 33 31 34

41–50 23 25 27 24 24 28 23

51–60 12 13 14 13 13 17 12

61–70 4 5 5 4 4 4 4

71–80 1 1 1 1 1 1 1

81+ 0 0 0 0 0 0 0

Total 100 100 100 100 100 100 100

Median age 37.0 38.0 39.0 37.0 37.0 40.0 36.0

Note: Components may not always add to 100% exactly because of rounding.

Table 9: Gender (start day)

Start day 6 months 12 months Q6 Record gender of the client

Total n=3101

%

Total n=1036

%

Quit n=276

%

Not quitn=760

%

Total n=1367

%

Quit n=320

%

Not quitn=1047

%

Wahine (female) 77 79 79 79 80 78 80

Tane (male) 23 21 21 21 20 22 20

Total 100 100 100 100 100 100 100



Table 10: Ethnicity (start day)

Start day 6 months 12 months Q8 Which of the following ethnic groups do you belong to?

Total n=3077

%

Total n=1056

%

Quit n=280

%

Not quitn=776

%

Total n=1386

%

Quit n=325

%

Not quit n=1061

%

Mäori 87 87 84 88 88 86 89

New Zealand European/Päkehä

21 23 25 22 20 20 20

Other European 3 3 3 4 3 3 2

Samoan 1 1 1 1 1 1 1

Cook Island Mäori 2 2 2 2 2 2 2

Tongan 1 0 0 0 0 0 0

Niuean 0 0 0 1 0 0 0

Other ethnicity 2 2 1 2 1 1 1

Refused 0 0 0 0 0 1 0

Don’t know 0 1 1 1 1 0 1

Total 100 100 100 100 100 100 100

Note: Total may exceed 100% because of multiple response.

Table 11: Children of your own (start day)

Start day 6 months 12 months Q32 Do you have any children yourself?

Sub-sample*

Total n=2268

%

Total n=780

%

Quit n=206

%

Not quitn=574

%

Total n=1037

%

Quit n=239

%

Not quit n=798

%

Yes, have children 83 84 83 84 83 84 82

No children 17 16 17 16 17 16 18

Total 100 100 100 100 100 100 100

Note: Components may not always add to 100% exactly because of rounding. * Only asked of women.


Table 12: Urban, rural location* (start day)

Start day 6 months 12 months

Total n=3208

%

Total n=1067

%

Quit n=282

%

Not quitn=785

%

Total n=1400

%

Quit n=326

%

Not quitn=1074

%

Major urban 65 49 57 47 59 59 60

Secondary urban 1 3 4 3 2 3 2

Minor urban 25 36 29 38 31 32 31

Rural centre 5 4 4 4 3 2 3

Rural location 2 5 3 6 2 2 2

Don’t know 1 1 1 1 1 1 1

No data 1 1 2 1 1 1 1

Total 100 100 100 100 100 100 100


* Note that the pilot programmes were delivered in seven discrete locations, so this distorted spread of participants was expected.

Table 13: Health status (start day)

Start day 6 months 12 months Q9 Do any of the following apply to you? Are you/ do you have ...? Total

n=3208 %

Total n=258

%

Quit n=76

%

Not quitn=182

%

Total n=351

%

Quit n=88

%

Not quitn=263

%

No health condition 67 76 73 77 75 73 76

Hapü (pregnant) 2 1 0 2 2 2 2

Breastfeeding 2 2 2 2 2 2 2

Cardiovascular disease 3 3 3 3 4 5 4

Asthma 13 13 15 12 14 13 14

High blood pressure 8 8 9 7 8 11 7

Total 100 100 100 100 100 100 100


Table 14: Education and learning (start day)

Start day 6 months 12 months Q37 Did you attend high school? (If not, what qualifications have you gained? Have you undertaken any formal training, on the job training, or training for employment? What did it involve?)

Total n=2645

%

Total n=811

%

Quit n=220

%

Not quitn=591

%

Total n=1139

%

Quit n=265

%

Not quitn=874

%

No high schooling 10 8 8 8 11 14 10

Attended high school 81 78 80 77 79 79 79

Attended polytechnic/university, etc 35 28 25 29 33 30 34

Other skills 40 36 33 36 31 28 32

Total 100 100 100 100 100 100 100



Table 15: Household size (start day)

Start day 6 months 12 months Q30 How many persons, including yourself, babies, children and boarders, live in your household?

Total n=3069

%

Total n=1030

%

Quit n=272

%

Not quitn=758

%

Total n=1355

%

Quit n=314

%

Not quit n=1041

%

One 7 8 8 8 7 8 7

Two 17 19 20 18 18 21 16

Three 18 17 16 17 17 18 17

Four 19 22 23 22 21 20 21

Five 16 16 16 15 17 15 17

Six 10 9 8 9 9 11 9

More than six 12 10 8 10 11 7 12

Total 100 100 100 100 100 100 100


Table 16: Children five years and under (start day)

Start day 6 months 12 months Q31 How many of these people are children aged five and under

Sub-sample*

Total n=2698

%

Total n=913

%

Quit n=238

%

Not quitn=675

%

Total n=1209

%

Quit n=275

%

Not quit n=934

%

None** 56 59 61 58 57 65 54

One 26 24 24 24 25 22 26

Two 12 12 10 12 12 10 13

Three 3 3 3 3 3 1 4

Four 1 1 2 1 1 1 2

Five 1 1 0 1 1 0 1

Six 0 0 0 0 0 0 0

More than six 1 1 0 1 1 0 1

Total 100 100 100 100 100 100 100


* Only those who live with one or more other people.

** A further 7% of all participants lived alone, so did not live with children under five. Accounting for those who live alone, 57% of all participants live with children under 5 years old.


Table 17: Employment status (start day)

Start day 6 months 12 months Q35 Which of the following describes your employment? Total

n=2910 %

Total n=982

%

Quit n=257

%

Not quitn=725

%

Total n=1303

%

Quit n=300

%

Not quitn=1003

%

Self-employed 5 7 8 6 5 8 4

Full-time salary or wage-earner 30 30 37 28 30 33 29

Part-time salary or wage-earner (less than 30 hours/week)

16 16 16 17 17 15 18

Retired 3 3 3 3 3 3 3

Full-time home-maker 11 12 9 13 11 8 12

Student 13 9 7 10 14 12 14

Unemployed 10 10 7 11 9 8 9

Other beneficiary 18 19 19 18 17 18 16

Total 100 100 100 100 100 100 100


Table 18: Community services card (start day)

Start day 6 months 12 months Q36 Do you have a community services card? Total

n=2925 %

Total n=927

%

Quit n=241

%

Not quitn=686

%

Total n=1244

%

Quit n=283

%

Not quitn=961

%

Yes 65 65 57 67 65 63 66

No 35 35 43 32 34 36 34

Don’t know 0 1 0 1 1 1 1

Total 100 100 100 100 100 100 100


Table 19: Phone ownership (start day)

Start day 6 months 12 months Q2e Do you have a phone?

Total n=3134

%

Total n=1050

%

Quit n=279

%

Not quitn=771

%

Total n=1382

%

Quit n=323

%

Not quitn=1059

%

Have a phone 90 92 94 91 91 92 90

Do not have a phone 10 8 6 9 9 8 10

Total 100 100 100 100 100 100 100



2.2 Smoking environment

Table 20: Partner’s smoking status (start day)

Start day 6 months 12 months Q34 If you have a partner (eg, husband/wife/de facto), which of the following describes your partner’s smoking status?

Total n=2935

%

Total n=991

%

Quit n=257

%

Not quitn=734

%

Total n=1303

%

Quit n=301

%

Not quitn=1002

%

Have no partner 32 31 28 32 32 30 32

They’ve never smoked regularly 13 14 15 14 14 12 14

They’re a past smoker 14 15 18 14 14 19 13

They’re a current smoker 41 40 39 40 40 39 41

Total 100 100 100 100 100 100 100


Table 21: Regular smokers in the house (start day)

Start day 6 months 12 months Q33 Including yourself, how many people living in your household are regular smokers?

Total n=2975

%

Total n=1001

%

Quit n=260

%

Not quitn=741

%

Total n=1322

%

Quit n=302

%

Not quitn=1020

%

One 40 42 45 40 40 43 40

Two 36 37 34 38 37 40 36

Three 14 12 15 11 13 13 13

Four 6 4 4 4 5 3 6

Five 2 3 1 3 2 1 3

Six 0 0 0 0 0 0 0


Don’t know 1 1 0 1 1 0 1

Total 100 100 100 100 100 100 100



Table 22: Smoking influences (start day)

Start day 6 months 12 months Q13 Social and physical influences on smoking

Total %

Total %

Quit %

Not quit%

Total %

Quit %

Not quit%

People you live with n=2989 n=1026 n=272 n=754 n=1346 n=316 n=1030

Mostly smokers 42 43 42 44 43 44 43

Half and half 20 18 18 18 18 16 19

Mostly auahi kore 38 39 40 38 38 41 38

Total 100 100 100 100 100 100 100

People you mix with most n=3006 n=1017 n=268 n=749 n=1338 n=315 n=1023

Mostly smokers 54 53 49 54 55 57 54

Half and half 35 36 37 36 35 33 36


Total 100 100 100 100 100 100 100

People at work n=2275 n=771 n=201 n=570 n=1037 n=239 n=798

Mostly smokers 38 37 32 38 38 40 38

Half and half 35 38 39 37 37 35 38


Total 100 100 100 100 100 100 100

Whare auahi kore (home) n=2742 n=955 n=248 n=707 n=1254 n=296 n=958

Mostly smoky 41 46 41 48 42 43 42

Half and half 16 17 20 16 16 16 17


Total 100 100 100 100 100 100 100

Waka auahi kore (car) n=2523 n=882 n=226 n=656 n=1173 n=275 n=898

Mostly smoky 49 51 50 51 48 47 48

Half and half 23 21 19 21 23 21 23


Total 100 100 100 100 100 100 100

Mahi auahi kore (work) n=2066 n=726 n=188 n=538 n=983 n=227 n=756

Mostly smoky 27 29 23 31 28 28 28

Half and half 25 24 28 22 26 28 25


Total 100 100 100 100 100 100 100

Total 100 100 100 100 100 100 100



2.3 Smoking/quitting history

Table 23: Tobacco consumption (start day)

Start day 6 months 12 months Q11 Over the last week how many cigarettes have you smoked per day? Total

n=3130 %

Total n=1020

%

Quit n=265

%

Not quitn=755

%

Total n=1353

%

Quit n=319

%

Not quitn=1034

%

1 to 10 24 28 29 28 25 28 24

11 to 20 40 38 38 38 39 34 40

21 to 30 25 23 22 23 24 26 23

31 or more 11 11 10 12 12 12 12

Total 100 100 100 100 100 100 100

Summary median* cigarettes per day

15.0 15.0 15.0 15.0 15.0 15.0 15.0


* Note: This is a summary median based on ranges so that ‘1–10’ is summarised as ‘5’, etc. Where an exact number is known (31 or more cigarettes per day), this is used to calculate the median.

Table 24: Level of addiction (start day)

Start day 6 months 12 months Q11 Over the last week how many cigarettes have you smoked per day (two slim rollies = one cigarette; one cigar = five cigarettes)?

Q12 How soon after you wake up do you smoke your first cigarette?

Total n=3098

%

Total n=1006

%

Quit n=261

%

Not quitn=745

%

Total n=1341

%

Quit n=314

%

Not quitn=1027

%

Low addiction 13 16 18 16 14 16 13

Medium addiction 38 44 44 44 40 39 41

High addiction 41 32 31 32 37 37 37

Very high addiction 8 8 7 8 9 8 9

Total 100 100 100 100 100 100 100


Note: Addiction level = tobacco consumption per day + time of first ‘smoke’ after waking. Low addiction = 0 or 1 points, medium addiction = 2 or 3 points, highly addicted = 4 or 5 points, very highly addicted = 6 points. Defined as per box below.

Q11. Number of cigarettes per day Q12. How soon after you wake up do you smoke your first cigarette?

(points) (points)

1 to 10 (0) Within 5 minutes (3)

11 to 20 (1) 6–30 minutes (2)

21 to 30 (2) 31–60 minutes (1)

31 or more (3) After 60 minutes (0)


Table 25: Age started smoking (start day)

Start day 6 months 12 months Q10b How old were you when you began regular smoking? Total

n=3122 %

Total n=1042

%

Quit n=276

%

Not quitn=766

%

Total n=1372

%

Quit n=320

%

Not quitn=1052

%

Under 15 44 41 36 43 44 38 45

15 to 19 years 45 46 52 44 44 49 43

20 to 29 years 10 11 9 11 11 12 10

30 to 39 years 2 2 2 2 1 1 2

Over 40 years 1 0 0 0 0 0 0

Total 100 100 100 100 100 100 100


Table 26: Years of smoking (start day)

Start day 6 months 12 months Q10d How many years have you smoked?

Total n=3126

%

Total n=1036

%

Quit n=274

%

Not quitn=762

%

Total n=1371

%

Quit n=320

%

Not quitn=1051

%

Less than 10 years 15 13 10 14 15 12 16

10 to 19 years 31 30 27 31 31 28 32

20 to 29 years 30 33 36 31 32 33 31

30 to 39 years 16 16 17 16 16 20 15

40 to 49 years 6 6 8 6 5 6 5

50 to 59 years 1 1 1 1 1 1 1

60 or more years 0 0 0 0 0 0 0

Total 100 100 100 100 100 100 100


Table 27: Ever attempted cutting down or quitting (start day)

Start day 6 months 12 months Q18 Have you ever ...?

Total n=3060

%

Total n=1034

%

Quit n=276

%

Not quitn=758

%

Total n=1361

%

Quit n=324

%

Not quitn=1037

%

Tried to cut down smoking 45 47 46 48 46 48 45

Tried to stop smoking completely

41 35 38 34 38 40 37

Never tried cutting down or stopping smoking

15 17 15 18 16 12 17

Total 100 100 100 100 100 100 100



Table 28: Number of attempts to completely quit (start day)

Start day 6 months 12 months Q19 How many times have you ever tried to stop smoking completely?

Sub-sample*

Total n=1224

%

Total n=360

%

Quit n=102

%

Not quitn=258

%

Total n=507

%

Quit n=127

%

Not quitn=380

%

One 33 38 34 39 35 30 36

Two 23 23 28 21 23 26 23

Three 16 17 17 17 17 17 18

Four 8 8 7 8 8 6 8

Five 4 4 2 5 4 5 4

Six 3 3 4 2 3 5 3


Too many times to remember 5 3 1 4 4 5 4

Can’t recall 2 1 1 0 1 1 2

Total 100 100 100 100 100 100 100


* Only those who had tried to stop smoking completely.

Table 29: Number of attempts to completely quit in the past three years (start day)

Start day 6 months 12 months Q20 And in the past three years, how many times have you tried to stop smoking completely?

Sub-sample*

Total n=1027

%

Total n=297

%

Quit n=83

%

Not quitn=214

%

Total n=446

%

Quit n=111

%

Not quitn=335

%

One 45 52 57 50 47 48 47

Two 21 18 19 18 20 24 19

Three 12 12 11 13 12 10 13

Four 3 2 2 1 2 1 2

Five 2 2 2 2 2 3 2

Six 3 2 1 2 2 2 2


Too many times to remember 3 2 2 2 3 4 3

Can’t recall 10 9 5 10 10 9 10

Total 100 100 100 100 100 100 100


* Only those who had tried to stop smoking completely.


Table 30: Length of time actually stopped on last quit attempt (start day)

Start day 6 months 12 months Q22 How long were you able to stop for (last quit attempt)?

Sub-sample* Total n=816

%

Total n=238

%

Quit n=69

%

Not quitn=169

%

Total n=327

%

Quit n=79

%

Not quitn=248

%

Up to 7 days 28 23 26 21 26 22 28

1 to 2 weeks 10 9 10 8 9 6 10

3 to 4 weeks/1 month 16 17 16 17 16 15 17

2 months 8 7 10 6 9 11 8

3 months 13 16 14 17 15 16 15

4 to 6 months 13 12 7 14 10 10 10

7 to 12 months 13 17 16 17 14 19 13

Total 100 100 100 100 100 100 100


* Only those who had tried to stop smoking completely in the past three years.

3 Access to alternative cessation products/services

3.1 Few participants accessed cessation product or services before

Table 31: Cessation products used by participants before the pilot programme (start day)

Start day 6 months 12 months Q29 Have you ever used nicotine gum, patches, spray or inhaler before, or any other non-nicotine based products such as Nicobrevin or herbal cigarettes? Which ones?

Total n=3077

%

Total n=1042

%

Quit n=276

%

Not quitn=766

%

Total n=1369

%

Quit n=319

%

Not quitn=1050

%

No products 74 75 72 76 78 75 79

Nicotine gum 9 10 10 10 9 9 9

Nicotine patches 14 10 12 10 9 10 8

Nicotine spray 1 1 0 2 1 1 1

Nicotine inhaler 1 1 2 1 1 2 1

Nicobrevin (a non-nicotine cessation product)

4 5 5 5 4 7 4

Other non-nicotine products such as herbal cigarettes

3 3 5 2 3 3 3

Don’t know 1 1 1 1 1 0 2

Total 100 100 100 100 100 100 100



Table 32: Contact with health professionals about smoking, breathing or heart within the past three months (start day)

Start day 6 months 12 months Q28 Apart from the 0800 Quitline, and the Quit coaches here on this pilot programme, in the past three months have you talked to your GP, practice nurse, a chemist, or any other health professional about your smoking or anything to do with your breathing or your heart?

Total n=3011

%

Total n=1019

%

Quit n=270

%

Not quitn=749

%

Total n=1339

%

Quit n=318

%

Not quitn=1021

%

Yes 37 37 37 37 37 36 38

No 62 62 62 62 62 63 61

Don’t know 1 1 1 1 1 0 1

Total 100 100 100 100 100 100 100


Table 33: Awareness of Quitline before the pilot programme (start day)

Start day 6 months 12 months Q25 Have you heard of the 0800 Quitline, a free telephone service that helps people to quit smoking?

Total n=3108

%

Total n=1050

%

Quit n=277

%

Not quitn=773

%

Total n=1372

%

Quit n=323

%

Not quitn=1049

%

Yes 60 57 57 56 60 58 61

No 40 43 42 43 39 41 39

Don’t know 1 0 0 1 0 1 0

Total 100 100 100 100 100 100 100


Table 34: Use of Quitline before the pilot programme (start day)

Start day 6 months 12 months Q26 Have you ever used the 0800 Quitline?


%

Total n=561

%

Quit n=148

%

Not quitn=413

%

Total n=776

%

Quit n=173

%

Not quitn=603

%

Never used the 0800 Quitline 81 83 77 85 83 79 84

To get a quit pack for self 9 9 11 6 9 10 9

Talked to advisors about quitting 9 8 11 4 8 5 7

Talked to advisors about smoking/ cutting back/other

4 4 5 1 4 3 4

To get a quit pack for someone else 1 1 1 8 1 10 1

Don’t know 2 3 3 3 2 3 1

Total 100 100 100 100 100 100 100


* Only those that had heard of Quitline prior to starting the pilot programme.


Table 35: Time since last spoke to Quitline before the pilot programme (start day)

Start day 6 months 12 months Q27 About how recently did you talk with a 0800 Quitline Advisor?

Sub-sample*

Total n=105

%

Total n=24**

%

Quit n=11**

%

Not quitn=13**

%

Total n=41

%

Quit n=13**

%

Not quitn=28**

%

In the last week 29 25 27 23 24 23 25

In the last month 20 33 27 38 24 15 29

In the last 3 months 18 21 18 23 20 15 21

In the last 3–6 months 10 13 18 8 12 15 11

More than 6 months ago 23 8 9 8 20 31 14

Total 100 100 100 100 100 100 100

Note: Components may not always add to 100% exactly because of rounding

* Only those who had spoken to an advisor at Quitline.

** Caution: low base number of respondents – results are indicative only.

3.2 Limited use of other cessation services or products whilst on the pilot programme

Table 36: Have you contacted Quitline (at three-month and six-month follow-up interviews)

3 months 6 months Q4 Since starting the pilot have you rung the 0800 Quitline?

At follow-up interview Total*n=514

%

Quit n=238

%

Not quitn=276

%

Total* n=443

%

Quit n=188

%

Not quitn=255

%

Yes 3 4 3 3 2 3

No 97 96 97 97 98 97

Total 100 100 100 100 100 100


* Note: Total excludes one site that did not record data accurately.

Table 37: Whether used other patches and gum while on the programme (at three-month and

six-month follow-up interviews)

3 months 6 months Q5 Since starting on the pilot have you used any gum or patches other than those you received from the quit coaches?

At follow-up interview

Total*n=516

%

Quit n=241

%

Not quitn=275

%

Total* n=417

%

Quit n=171

%

Not quitn=246

%

Yes, some I got myself 2 0 4 1 1 1

No, only used ones from coaches/not used any at all

96 96 96 94 93 94

Never used any at all 2 4 0 5 6 4

Total 100 100 100 100 100 100




Table 38: Whether used other products, methods or other support while on the programme (at three-month and six-month follow-up interviews)

3 months 6 months Q6 Since starting on the pilot have you used any other products, methods or other support to help you quit smoking?

At follow-up interview

Total*n=513

%

Quit n=239

%

Not quitn=274

%

Total*n=452

%

Quit n=359

%

Not quitn=93

%

Yes 3 4 3 4 4 4

No 97 96 97 96 96 96

Total 100 100 100 100 100 100



4 Access to Aukati Kai Paipa 2000

4.1 Access to programme and confidence in it

Table 39: How participants found out about Aukati Kai Paipa (start day)

Start day 6 months 12 months Q38 How did you hear about this pilot programme?

Total n=3023

%

Total n=1051

%

Quit n=275

%

Not quitn=776

%

Total n=1373

%

Quit n=322

%

Not quitn=1051

%

This health service 16 19 23 18 16 17 15

Another Mäori health provider 13 13 13 13 13 15 12

GP or other health professional 6 5 5 5 4 2 4

Whänau 34 33 30 34 33 30 34

Marae 6 5 6 5 5 5 5

Word of mouth 25 27 31 26 24 20 25

Friends 28 33 33 33 31 31 30

Work colleagues 8 10 11 10 10 8 11

Kohanga reo, kura kaupapa 4 3 2 3 5 3 5

Panui 2 2 3 2 2 2 2

Posters or pamphlets 3 2 3 2 2 1 2

Newspaper 2 2 3 2 2 3 2

Radio 2 3 4 3 2 2 2

Television 2 2 2 2 2 2 2

Other media 0 1 1 1 1 1 0

0800 Quitline 2 2 3 2 2 2 2

Other 4 4 4 4 4 4 4

Total 100 100 100 100 100 100 100



Table 40: Level of confidence to succeed (start day)

Start day 6 months 12 months Q40 On a scale of 1–7, how confident are you that you can or cannot succeed in stopping smoking in the next eight weeks while on this programme?

Total n=3045

%

Total n=1027

%

Quit n=270

%

Not quitn=757

%

Total n=1344

%

Quit n=316

%

Not quitn=1028

%

I’ll definitely be able to stop (very confident)

36 32 37 31 33 36 32

6 17 18 15 19 16 16 16

5 15 16 17 16 15 13 16

I should be able to do it (reasonably confident)

27 27 26 28 29 28 30

3 2 2 3 2 2 3 2

2 1 1 0 1 1 1 1

I won’t be able to do it (not confident)

1 1 0 1 1 0 1

Don’t know 2 3 2 3 2 3 2

Total 100 100 100 100 100 100 100


4.2 Participant perceptions of Aukati Kai Paipa

Table 41: Helpfulness of Aukati Kai Paipa (at three-month, six-month and 12-month follow-up interviews)

3 months 6 months 12 months Q1 Compared to other programmes and other ways of quitting smoking, do you think the Aukati Kai Paipa (smoking cessation) pilot has been more helpful or less helpful?

Totaln=388

%

Quitn=188

%

Not quitn=200

%

Totaln=409

%

Quitn=170

%

Not quit n=239

%

Total n=886

%

Quitn=299

%

Not quitn=587

%

Much more helpful 94 97 92 92 94 90 80 89 75

A bit more helpful 4 2 5 5 2 7 10 6 12

No different than others 1 0 2 0 0 0 3 2 4

A bit less helpful 0 0 1 0 1 0 1 0 2

Much less helpful 0 0 0 0 0 0 0 0 1

Don’t know 1 1 1 2 3 2 5 2 7

Total 100 100 100 100 100 100 100 100 100



Table 42: Confident you can stay quit/will quit (at three-month, six-month and 12-month follow-up interviews)

3 months 6 months 12 months Q10 On a scale of 1–7 how confident are you that you can stay quit or will quit? Total

n=436 %

Quitn=290

%

Not quitn=146

%

Totaln=336

%

Quitn=220

%

Not quitn=116

%

Total n=444

%

Quit n=297

%

Not quitn=147

%

I’ll definitely be able to stay quit (very confident)

31 40 13 40 54 14 50 61 29

6 21 26 10 22 27 12 18 18 17

5 21 19 25 14 9 22 10 8 15

I should be able to do it (reasonably confident)

11 10 15 7 4 13 10 8 13

3 1 1 3 1 1 2 4 1 10

2 8 0 23 10 0 27 2 0 5

I won’t be able to do it (not confident) 4 1 10 4 0 9 1 0 2

Don’t know 3 3 1 3 4 1 6 3 10

Total 100 100 100 100 100 100 100 100 100


Table 43: Friend and whänau support (at three-month and six-month follow-up interviews)

3 months 6 months Q1 Overall, thinking about the people you live with, your friends and whänau, how supportive have they been while you were trying to quit smoking?

Total n=683

%

Quit n=286

%

Not quitn=397

%

Total n=636

%

Quit n=241

%

Not quit n=395

%

Very supportive 71 82 63 67 80 59

A bit supportive 11 9 12 12 9 13

Neither supportive nor unsupportive 9 4 13 12 7 16

A bit unsupportive 3 1 4 4 1 6

Very unsupportive 3 1 4 2 0 3

Don’t know 3 3 3 3 2 3

Total 100 100 100 100 100 100



5 Outcome of Aukati Kai Paipa

5.1 Quit rates achieved (point prevalence)

Table 44: Quit rate for Aukati Kai Paipa (at three-month, six-month and 12-month follow-up interviews

3 months total* n=1099

%


%


%

Quit** 31 26 23

Not quit# 69 74 77

Total 100 100 100


* Note: Includes data from pilot providers that collected at least half the data expected (eg, follow-up data on at least 250 out of 500 clients).

** Note: ‘Quit’ includes those who had not smoked for two days, who do not have occasional puffs.

# Note: ‘Not quit’ includes those who have not smoked for two days but have occasional puffs and those currently smoking and those who were not followed up.

Table 45: Quit rate for Mäori women/wähine (at three-month, six-month and 12-month follow-up

interviews)

3 months total n=738

%


%


%

Quit 31 26 23

Not quit 69 74 77

Total 100 100 100


Table 46: Quit rate by tried to quit completely, tried to cut down or not tried prior to programme

(quit status at six-month and 12-month follow-up interviews)

6 months 12 months

Tried to quit n=489

%

Tried cut downn=367

%

Not tried n=178

%

Tried to quitn=626

%

Tried cut down n=516

%

Not tried n=219

%

Quit 26 29 24 25* 25** 17

Not quit 74 71 76 75 75 83

Total 100 100 100 100 100 100


* p<0.01 compared to quit rate for those not tried.

** p<0.05 compared to the quit rate for those not tried.


Table 47: Quit rate for different levels of addiction to tobacco at start day (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

Low addicted

n=163 %

Medium addicted

n=441 %

Highly addicted

n=322 %

Very highly addicted

n=80 %

Low addicted

n=183 %

Medium addicted

n=542 %

Highly addicted

n=497 %

Very highly addicted

n=119 %

Quit 28 26 25 21 28 23 23 22

Not quit 72 74 75 79 72 77 77 78

Total 100 100 100 100 100 100 100 100


Table 48: Quit rate for tobacco consumption at start day (quit status at six-month and 12-month

follow-up interviews)

6 months 12 months

1–10 cig/day n=289

%

11–20 cig/day n=386

%

21–30 cig/day n=232

%

31+ cig/dayn=113

%

1–10 cig/dayn=341

%

11–20 cig/dayn=525

%

21–30 cig/day n=325

%

31+ cig/day n=162

%

Quit 27 26 25 23 26 21 26 23

Not quit 73 74 75 77 74 79 74 77

Total 100 100 100 100 100 100 100 100


Table 49: Quit rate by whether NRT was prescribed at start day (quit status at six-month and

12-month follow-up interviews)

6 months 12 months

NRT prescribed n=1002

%

No prescription n=65

%

NRT prescribedn=1244

%

No prescription n=156

%

Quit 27 22 24* 18

Not quit 73 78 76 82

Total 100 100 100 100


* p<0.1 compared with those with no prescription (p=0.036 at 90% confidence interval, p=0.069 at 95% confidence interval).


Table 50: Quit rate with different NRT prescription types at start day (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

Gum only total n=68

%

Patches only total

n=414 %

Gum and patches total

n=520 %

No NRT total n=65

%

Gum only total n=66

%

Patches only total

n=476 %

Gum and patches total

n=702 %

No NRT total

n=156 %

Quit 26 26 28 22 32 25 23 18

Not quit 74 74 72 78 68 75 77 82

Total 100 100 100 100 100 100 100 100


Table 51: Quit rate by age at start day (quit status at six-month and 12-month follow-up

interviews)

6 months 12 months

Under 20 total n=42*

%

21–30 total

n=183 %

31–40 total

n=333 %

41–50 total

n=241%

51–60 total

n=128%

61–70 total

n=46*%

Under 20 total

n=60%

21–30 total

n=272%

31–40 total

n=431 %

41–50 total

n=314 %

51–60 total

n=170%

61–70 total

n=48*%

Quit 2 25 27 29 27 30 8** 21 22 27 29 25

Not quit 98 75 73 71 73 70 92 79 78 73 71 75

Total 100 100 100 100 100 100 100 100 100 100 100 100


* Caution: low base number of respondents – results are indicative only.

** p<0.01 for those aged under 20 years compared to those in their 20s, 30s, 40s, or 50s.

Table 52: Quit rate by health at start day (quit status at six-month and 12-month follow-up

interviews)

6 months 12 months

Hapü total

n=14* %

Breast-feeding

total

n=24* %

Cardio-vascular disease

total n=36*

%

Asthma total

n=136%

High blood

pressure total n=85

%

Hapü total

n=25*%

Breast-feeding

total

n=30* %

Cardio-vascular disease

total n=55

%

Asthma total

n=192%

High blood

pressure total

n=115%

Quit 7 29 25 30 31 20 23 29 21 30

Not quit 93 71 75 70 69 80 77 71 79 70

Total 100 100 100 100 100 100 100 100 100 100




Table 53: Quit rate by partner smoking status at start day (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

Have no partner

total n=307

%

Never smoked regularly

total n=140

%

Past smoker

total n=151

%

Current smoker

total n=393

%

Have no partner

total n=412

%

Never smoked regularly

total n=182

%

Past smoker

total n=185

%

Current smoker

total n=524

%

Quit 24 27 31 25 22 20 31* 22

Not quit 76 73 69 75 78 80 69 78

Total 100 100 100 100 100 100 100 100


* p<0.05 compared to those whose partners had never smoked regularly, whose partners were current smokers or who had no partner.

Table 54: Quit rate by partner smoking status at 12 months (quit status at 12-month follow-up

interview)

Have no partner total n=170

%

Never smoked regularly totaln=61

%

Past smoker total n=78

%

Current smoker total n=166

%

Quit 32 39 44 26

Not quit 68 61 56 74

Total 100 100 100 100


Table 55: Quit rate by number of regular smokers in house at start day (quit status at six-month

and 12-month follow-up interviews)

6 months 12 months

One total

n=416 %

Two total

n=371 %

Three total

n=119 %

Four or more total

n=85 %

One total

n=533 %

Two total

n=483 %

Three or more total

n=176 %

Four or more total

n=119 %

Quit 28 24 32 19 24* 25* 22 10

Not quit 72 76 68 81 76 75 78 90

Total 100 100 100 100 100 100 100 100


* p<0.001 compared to those who lived with four or more smokers.


Table 56: Quit rate by number of regular smokers in house at 12 months (quit status at 12-month follow-up interview)

None total n=197

%

One total n=213

%

Two total n=111

%

Three total n=25*

%

Four or more totaln=20*

%

Quit 64 24 23 18 25

Not quit 36 76 77 82 75

Total 100 100 100 100 100



Table 57: Quit rate by length of last quit attempt prior to starting programme (quit status at six-

month and 12-month follow-up interviews)

6 months 12 months

Up to 7 days total n=54

%

1–2 weeks total

n=23*%

3–4 weeks/

1 month total

n=40* %

2 months totaln=17*

%

3 months totaln=38*

%

4–6 months totaln=29*

%

7–12 months totaln=41*

%

Up to 7 days totaln=86

%

1–2 weeks total

n=32*%

3–4 weeks/

1 month total n=53

%

2 months total n=29*

%

3 months total n=50

%

4–6 months total n=34*

%

7–12 months total n=47*

%

Quit 33 35 28 41 26 17 29 20 16 23 31 26 24 32

Not quit 67 65 73 59 74 83 71 80 84 77 69 74 76 68

Total 100 100 100 100 100 100 100 100 100 100 100 100 100 100



Table 58: Quit rate by total number of packets of gum as recorded by quit coach for each

participant (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

1 or 2 packs total

n=112 %

3 or 4 packs total

n=88 %

5 or 6 packs total

n=81 %

7 or 8 packs total

n=66 %

9 or more packs total

n=236 %

1 or 2 packs total

n=110 %

3 or 4 packs total

n=127 %

5 or 6 packs total

n=91 %

7 or 8 packs total

n=100 %

9 or more packs total

n=317 %

Quit 29 16 32 35 31 22 15 20 28 30

Not quit 71 84 68 65 69 78 85 80 72 70

Total 100 100 100 100 100 100 100 100 100 100



Table 59: Quit rate by total packets of patches provided as recorded by quit coach for each participant (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

No patches

total n=264

%

Less than 4 weeks patches

total n=259

%

4–8 weeks

patches total

n=368 %

9–12 weeks

patches total

n=129 %

13 or more weeks

patches totaln=47*

%

No patches

total n=468

%

Less than 4 weeks patches

total n=291

%

4–8 weeks

patches total

n=443 %

9–12 weeks

patches total

n=138 %

13 or more weeks

patches totaln=60

%

Quit 25 21 27 33 38 21 17 29 23 27

Not quit 75 79 73 67 62 79 83 71 77 73

Total 100 100 100 100 100 100 100 100 100 100



Table 60: Quit rate by total number of occasions provided with gum as recorded by quit coach

for each participant (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

No gum total

n=283

%

1 or 2 times total

n=173 %

3 or 4 times total

n=151%

5 or 6 times total

n=105 %

7 or 8 times total n=65

%

9 or more times total n=91

%

No gum total

n=264

%

1 or 2 times total

n=253%

3 or 4 times total

n=210%

5 or 6 times total

n=121%

7 or 8 times total n=73

%

9 or more times total n=90

%

Quit 24 29 25 30 34 30 25 20 26 28 33 23

Not quit 76 71 75 70 66 70 75 80 74 72 67 77

Total 100 100 100 100 100 100 100 100 100 100 100 100


Table 61: Quit rate by total number of occasions provided with patches, as recorded by quit

coach for each participant (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

1 or 2 weeks total

n=161 %

3 or 4 weeks total

n=183 %

5 or 6 weeks total

n=178 %

7 or 8 weeks total

n=121 %

9 or more weeks total

n=176 %

1 or 2 weeks total

n=160 %

3 or 4 weeks total

n=183 %

5 or 6 weeks total

n=167 %

7 or 8 weeks total

n=117 %

9 or more weeks total

n=176 %

Quit 24 28 33 39 39 24 17 27 34 35

Not quit 76 72 67 61 61 76 83 73 66 65

Total 100 100 100 100 100 100 100 100 100 100



Table 62: Quit rate by total number of occasions provided with NRT – patches and/or gum as recorded by quit coach for each participant (quit status at six-month and 12-month follow-up interviews)

6 months 12 months

1 or 2 times total

n=136 %

3 or 4 times total

n=178 %

5 or 6 times total

n=145 %

7 or 8 times total

n=106%

9 to 15 times total

n=181%

16 or more times total

n=117 %

1 or 2 times total

n=161%

3 or 4 times total

n=224%

5 or 6 times total

n=176 %

7 or 8 times total

n=118 %

9 to 15 times total

n=210%

16 or more times total

n=117 %

Quit 27 21 23 25 31 36 20 22 26 35* 27 22

Not quit 73 79 77 75 69 64 80 78 74 65 73 78

Total 100 100 100 100 100 100 100 100 100 100 100 100


* p<0.05 compared to those who had been provided NRT 16 or more times, one or two times, or three or four times.

5.2 Broader quit rate measure for comparison with other smoking cessation programmes

The following two tables provide quit rates for comparison with other smoking cessation programmes in New Zealand and Australia. See Appendix A, Section 7 for further commentary. Table 63 provides quit rates for comparing with other New Zealand smoking cessation programmes that use cohort surveys, such as Quitline New Zealand and Quit For Our Kids. Data for these will be available in 2003. This quit rate is the less conservative quit rate reported in the main report for Aukati Kai Paipa 2000. Table 63: Point prevalence quit rate for comparison with New Zealand cohort studies (includes

those not spoken to and disregards occasional puffs)

Quit rate for Aukati Kai Paipa*

3 months n=1099

%

6 months n=1067

%

12 months n=1400

%

Quit** 39 32 30

Not quit# 61 78 70

Total 100 100 100



** Note: ‘Quit’ includes those who had not smoked for 2 days. They may have occasional puffs.

# Note: ‘Not quit’ includes those who are currently smoking, or who were not followed up.

Table 64 provides quit rates for comparing with Quitline Australia – much of the research on Quitline Australia reports only those spoken to at follow-up.


Table 64: Point prevalence quit rate for comparison with Quitline Australia – excludes those not spoken to at follow-up and disregards occasional puffs)

Quit rate for Aukati Kai Paipa* Quit rate for Quitline Australia

3 months n=828

%

6 months n=793

%

12 months n=978

%

6 months n=676

%

12 months n=494

%

Quit** 51 43 43 24 29

Not quit# 49 57 57 76 71

Total 100 100 100 100 100



** Note: ‘Quit’ includes those who had not smoked for two days. They may have occasional puffs.

# Note: ‘Not quit’ includes those who are currently smoking.

Those who were not followed up are not included in the quit rate calculation.

5.3 The programme has provided access to Nicotine Replacement Therapy and counselling

Table 65: Proportion of participants prescribed Nicotine Replacement Therapy (start day)

Prescribed NRT at start dayn=3208

%

Patches at start dayn=3208

%

Gum on start day n=3208

%

All participants 89 83 52

Hapü 71 61 31

Breastfeeding 79 72 47

Cardiovascular disease 88 80 51

Asthma 87 81 53

High blood pressure 86 79 45

Total 100 100 100



Table 66: Total number of packets of gum provided (as recorded by quit coach or each participant)

Start day 6 months 12 months Sub-sample*

Total n=1759

%

Total n=868

%

Quit n=235

%

Not quitn=633

%

Total n=1011

%

Quit n=251

%

Not quitn=760

%

No gum 30 33 29 34 26 27 26

1 or 2 times 13 13 14 12 11 10 11

3 or 4 times 12 10 6 12 13 8 14

5 to 6 times 8 9 11 9 9 7 10

7 to 8 times 8 8 10 7 10 11 9

9 or more times 28 27 31 26 31 38 29

Total 100 100 100 100 100 100 100


* Note: Those for whom this data was recorded by the quit coaches.

Table 67: Total number of packets of patches provided (as recorded by quit coach for each

participant)


Total n=1759

%

Total n=868

%

Quit n=235

%

Not quitn=633

%

Total n=1011

%

Quit n=251

%

Not quitn=760

%

No patches 7 7 8 7 8 10 7

1 or 2 times 22 18 16 19 18 11 21

3 or 4 times 21 21 14 24 23 20 24

5 to 6 times 18 19 19 19 18 21 17

7 to 8 times 12 13 17 12 13 20 11

9 or more times 20 20 26 18 20 19 20

Total 100 100 100 100 100 100 100




Table 68: Total number of occasions provided with gum (as recorded by quit coach for each participant)


Total n=1759

%

Total n=868

%

Quit n=235

%

Not quitn=633

%

Total n=1011

%

Quit n=251

%

Not quit n=760

%

No gum 30 33 29 34 26 27 26

1 or 2 times 27 20 21 19 25 20 27

3 or 4 times 19 17 16 18 21 22 20

5 to 6 times 10 12 14 12 12 14 11

7 to 8 times 6 7 9 7 7 10 6

9 or more times 9 10 11 10 9 8 9

Total 100 100 100 100 100 100 100



Table 69: Total number of occasions provided with patches (as recorded by quit coach for each

participant)


Total n=1759

%

Total n=868

%

Quit n=235

%

Not quitn=633

%

Total n=1011

%

Quit n=251

%

Not quit n=760

%

No patches 7 7 8 7 8 10 7

1 or 2 times 29 22 19 24 27 21 29

3 or 4 times 25 25 17 28 26 25 26

5 to 6 times 17 19 21 18 17 20 16

7 to 8 times 9 12 16 10 10 12 9

9 or more times 13 14 19 12 12 11 13

Total 100 100 100 100 100 100 100




Table 70: Total number of occasions provided with NRT – gum or patches (as recorded by quit coach for each participant)


Total n=1759

%

Total n=868

%

Quit n=235

%

Not quitn=633

%

Total n=1011

%

Quit n=251

%

Not quitn=760

%

No gum or patches 1 1 0 1 0 0 1

1 or 2 times 19 16 16 16 16 13 17

3 or 4 times 21 21 16 22 22 20 23

5 to 6 times 17 17 14 18 17 18 17

7 to 8 times 11 12 11 13 12 16 10

9 or more times 31 34 42 31 32 33 32

Total 100 100 100 100 100 100 100



Table 71: Total number of contacts (as recorded by quit coach for each participant)


Total n=2232

%

Total n=1007

%

Quit n=272

%

Not quitn=735

%

Total n=1312

%

Quit n=314

%

Not quitn=998

%

1 or 2 contacts 20 11 7 13 14 5 16

3 or 4 contacts 20 17 9 21 20 17 20

5 or 6 contacts 17 19 18 20 18 20 17

7 or 8 contacts 13 15 20 13 15 17 14

9 or more contacts 29 37 46 33 34 40 32

Total 100 100 100 100 100 100 100




Table 72: Type of contacts (as recorded by quit coach for each participant)

Start day Sub-sample*

One-on-one total

n=2232

%

Group session

total n=2232

%

Letter contacts

total n=2232

%

Phone contacts

total n=2232

%

Informal contacts

total n=2232

%

Extra contacts

total n=2232

%

None 31 70 98 42 74 98

1 or 2 contacts 29 16 2 28 17 1

3 or 4 contacts 16 6 0 15 5 0

5 or 6 contacts 9 3 0 7 1 0

7 or 8 contacts 6 2 0 4 1 0

9 or more contacts 8 2 0 4 1 0

Total 100 100 100 100 100 100



5.4 Whänau have accessed the programme

Table 73: Whänau already on the programme when participants started (start day)

Start day 6 months 12 months Q5 What relation are these whänau to you?


%

Total n=333

%

Quit n=91

%

Not quitn=242

%

Total n=442

%

Quit n=115

%

Not quitn=327

%

Female partner/wife/de facto 14 18 21 17 17 17 17

Mother/daughter/sister 14 17 21 15 18 15 19

Other female relative 6 10 8 10 9 4 10

Male partner/ husband/de facto 8 13 10 14 10 10 10

Father/brother/son 4 4 5 4 4 3 5

Other male relative 2 2 0 3 4 3 5

Other person 5 3 4 2 7 7 7

Refused 0 0 0 0 0 0 0

Don’t know 16 1 1 1 2 3 2

No whänau already taking part 37 40 37 41 39 44 37

Total 100 100 100 100 100 100 100


* Note: Those who had whänau on the programme at all.


Table 74: Proportion of participants with close whänau (people in their own household) on the programme (start day)

Start day 6 months 12 months

Total n=3208

%

Total n=1067

%

Quit n=282

%

Not quitn=785

%

Total n=1400

%

Quit n=326

%

Not quitn=1074

%

On programme on own 73 78 78 78 75 75 75

Two people in household 22 19 21 19 21 22 20

Three people in household 3 0 0 1 2 3 2

Four or more people in household

1 0 0 0 1 0 1

No data 2 2 2 2 2 0 2

Total 100 100 100 100 100 100 100


5.5 Decreased tobacco consumption

Table 75: Tobacco consumption of those currently smoking at follow-up (tobacco consumption at start day and at six-month and 12-month follow-up interviews)

Q11 Over the last week how many cigarettes have you smoked per day?

Start day total n=3130

%

6 months not quit n=262

%

12 months not quit n=505

%

1 to 10 24 61 51

11 to 20 40 32 38

21 to 30 25* 5 8

31 or more 11 1 3

Total 100 100 100


* p<0.0001 36% smoked more than 20 cigarettes per day at start day compared to 6% at six months and 11% at 12 months.


5.6 Changes in smoking environment (more smokefree)

Table 76: Partner’s smoking status at start of programme compared to partner’s smoking status recorded at 12 months (start day and at 12-month follow-up interview)

Start day 12 months Q34 If you have a partner (eg, husband, wife, de facto), which of the following describes your partner’s smoking status?

Q3 If you have a partner (eg, husband, wife, de facto), which of the following describes your partner’s smoking status?

Total n=2935

%

Total n=475

%

Quit n=155

%

Not quitn=320

%

Have no partner 32 36 35 36

They’ve never smoked regularly 13 13 15 12

They’re a past smoker 14 16 22 14

They’re a current smoker 41 35* 28** 38

Total 100 100 100 100


* p<0.05 35% had a partner who was a current smoker compared to 41% at start day.

** p<0.05 28% of those quit had a partner who was a current smoker compared to 38% of those not quit.

Table 77: Smoking status of household at start of programme compared to smoking status of

household recorded at 12 months (start day and at 12-month follow-up interview)

Start day 12 months Q33 Including yourself, how many people living in your household are regular smokers?

Q2 Including yourself, how many people living in your household are regular smokers?

Total n=2975

%

Total n=896

%

Quit n=299

%

Not quitn=597

%

No smokers in the household – 26 51 14*

One 40 37 26 42

Two 36 20 14 24

Three 14 7 4 8

Four 6 4 2 5

Five 2 2 2 2

Six 0 1 1 1

More than six 1 2 1 2

Don’t know 1 1 0 1

Total 100 100 100 100


* 14% of ‘not quit’ participants reported no current smokers in their household because although they were not currently smoking (had not smoked for the two days prior to follow-up) they did report that they have ‘a few occasional puffs’ so were categorised as ‘not quit’ for analysis purposes.


Table 78: Smoking influences at start of programme compared to smoking influences recorded at 12 months (start day and at 12-month follow-up interview)

Start day 12 months Q13 Social and physical influences on smoking (start day). Q4 Social and physical influences of smoking (12 months). Total

% Total

% Quit

% Not quit

%

People you mix with most n=3006 n=888 n=296 n=592

Mostly smokers 54 34 24 40

Half and half 35 45 47 44

Mostly auahi kore105 11 14 17 13

Totally auahi kore – 6 11 4

Total 100 100 100 100

People at work n=2275 n=704 n=229 n=475

Mostly smokers 38 27 26 27


Mostly auahi kore 27 20 17 21


Total 100 100 100 100

Whare auahi kore (home) n=2742 n=876 n=295 n=581

Mostly smoky 41 19 13 23




Total 100 100 100 100

Waka auahi kore (car) n=2523 n=823 n=277 n=546





Total 100 100 100 100

Mahi auahi kore (work) n=2066 n=678 n=225 n=453





Total 100 100 100 100


105 Auahi kore is smokefree.


Table 79: Whether children under 5 in household by smoky/smokefree environments (environment at 12-month follow-up interviews)

Start day

12 months with under 5s in house

Start day

12 months without under 5s in house

Total %

Total %

Quit %

Not quit%

Total%

Total %

Quit %

Not quit%

People mix with n=515 n=347 n=92 n=255 n=663 n=421 n=162 n=259

Mostly smokers 57 37 27 41 53 32 23 37

Half and half 33 46 48 45 37 46 46 46

Mostly auahi kore 9 11 13 11 10 15 19 13

Totally auahi kore – 5 12 3 – 7 12 4

Total 100 100 100 100 100 100 100 100

People work with n=380 n=266 n=70 n=196 n=532 n=357 n=132 n=225

Mostly smokers 43 24 26 24 35 28 27 28

Half and half 35 47 44 48 37 39 38 39



Total 100 100 100 100 100 100 100 100

Whare auahi kore (home) n=487 n=344 n=92 n=252 n=615 n=416 n=162 n=254

Mostly smoky 35 15 9 17 48 24 15 29

Half and half 18 21 18 22 15 16 9 20



Total 100 100 100 100 100 100 100 100

Waka auahi kore (car) n=467 n=338 n=91 n=247 n=574 n=384 n=149 n=235

Mostly smoky 43 22 8 28 51 24 14 31

Half and half 27 19 11 21 20 16 8 21



Total 100 100 100 100 100 100 100 100

Mahi auahi kore (work) n=371 n=267 n=70 n=197 n=494 n=340 n=128 n=212

Mostly smoky 28 15 13 16 27 16 13 18

Half and half 25 31 23 34 25 22 22 22



Total 100 100 100 100 100 100 100 100



5.7 Perceived health changes

Table 80: Health changes (at 12-month follow-up interview)

Q5 Have you noticed any good or bad changes in your health since you started on this programme 12 months ago?

Total n=843

%

Quit n=293

%

Not quitn=550

%

Yes, good changes 58 73 50

Yes, bad changes 9 9 10

No changes 14 8 17

Don’t know 19 10 23

Total 100 100 100


5.8 Example comments – reasons for quitting, staying quit or relapsing

Table 81: Reasons for quitting

My grandparents both died of smoking. I did not want Mum to see me die of smoking as well. It does not teach self-respect. God made my body to be used as a temple, not to be abused with substances. I want to be alive a lot longer and look nice for my partner and daughter. I do not want to die before them. For better health, and my friends were giving up around me. Price increases, poor general health, fear for my children’s health I was scared of cot death as I have a young baby. Diabetes runs in my family and smoking helps that along. Mainly for the children being a young family and being asthmatic. We know smoking is unhealthy so there’s that too. To improve my health and save money. Money, health. Didn’t like my stink breath and clothes. To become smokefree, save money, for my children’s health, for my own health’s sake. Save money, smokefree environment for kids’ house, health reasons. For my health, children’s health, save money. Tamariki, health, money. My children being left without a mum, health, money, general wellbeing. Role model for young, smell better, healthier, stay younger-looking, monies saved, house smells good, more commitment to my nursing studies, confidence in other challenges. Personal health reason, getting scared, not getting any younger, role model for tamariki, fitter/more energy. Save money, mother recently died of suspected tumour possibly lung cancer. Need to be role model. Smokefree, better quality of life. My daughter’s and son’s health. My own health. Becoming fitter. Breathing better. Not getting sick all the time. Not smelling stink ashtrays and having to clean them. Not smelling like cigarette smoke. Having a better mind and body. Not having to crave for smokes. Feeling better about myself. Stress, stress, stress. Kai. My ex-husband. Use patches and gum. My kids. Living long enough to see my grandchildren. Support groups would be a big help. Won’t have to worry about smoking in public, smoke-free when I do hongi not offending anyone, whänau hates smoking, won’t buy cigarettes.


Table 82: Reasons for staying quit

Fear of weight increase. I have a new baby. I want an auahi kore whänau and home. Money will make me give up and health of kids. My moko, I feel good within myself. Role model for whänau. Price keeps increasing. Want to stay smokefree. Healthier. Because I can do it. Financial. Health and my mokopuna. My entire whänau are smokefree. I am very proud of myself and my efforts. I don’t want to pick up another cigarette. Don’t want to go back there. Healthier body, role model for children. Enjoying my food, more energy.

Table 83: Reasons for relapse

Whänau death. I attended five tangi within the whänau during the time I was on the programme. The whänau were supporting my being smokefree, but it got the better of me. With everyone smoking around me, I started smoking again. My husband died. Grandmother’s death. Dad was ill. Just thought one cigarette would be enough. Wanted to socialise again. Constantly being around smokers. Boredom. No will power. I stopped for about 10 weeks, then I had strong cravings and started smoking again. Stress and others smoking around me. Stressed out and nothing to do. Stress, moving, job-hunting. Work-related stress. Family problems. Hip problems. Brother told me to smoke. Others smoking, environment. Party, drinking, socialising. Weight gain, grumpiness, not completely committed. Got behind in studies, stressed out. Started drinking, going out. Social scene. People kept smoking around me, started asking for a puff, too much temptation. Started to play rugby league and going to the club again. Nothing to do, got bored, weight gain, really missed it. Marriage, stress, employment, etc.


Appendix E: Baseline Survey of Mäori Women not on Aukati Kai Paipa 2000 – Data Tables

1 Baseline research

1.1 Overview – baseline survey The baseline research was conducted as a further means of evaluating the effectiveness of the Aukati Kai Paipa 2000 pilot programme. Its main aim was to determine the latent quit rate over a 12-month period for Mäori women not on the pilot programme. Over 4500 Mäori women were contacted. Nearly three-quarters (70%) of these Mäori women identified themselves as smokers or recent quitters. In total, n=411 who were currently quit (quit in the previous 12 months) and were wanting to quit were interviewed in full for the baseline survey. Following the survey, the self-reported latent quit rate, over a 12-month period, for the female, adult Mäori population was calculated at 12.5%. These rates (smoking and quitting rates), measured by the baseline survey, are the same as two similar telephone studies by Laugesen and McClellan carried out in 1991 and 1996 (Laugesen and McClellan 1999). Laugesen and McClellan commented that the smoking rate for Mäori, of approximately 70%, was different from that identified through the census in 1996, probably due to a greater quitting success among those who own telephones or who agreed to participate in the telephone survey. The profiles of baseline survey respondents were generally the same as those for Aukati Kai Paipa participants. The demographic profile, the environmental situations, the smoking environment and smoking/quitting history profiles were similar to those of Aukati Kai Paipa participants. However, the tobacco consumption levels for respondents on the baseline survey were significantly lower than for the participants in Aukati Kai Paipa 2000.

1.2 Rationale and objectives The baseline research was conducted as a further means of evaluating the effectiveness of the Aukati Kai Paipa 2000 pilot programme. Its main aim was to measure the latent quit rate of Mäori women in the general population (ie, a measure of how many Mäori women quit smoking in a 12-month period without the assistance of the Aukati Kai Paipa 2000 pilot programme). Other information relating to smoking, quitting and demographic data was collected to provide comparison with data collected from programme participants. The specific objectives of the baseline survey were therefore:

• to determine what proportion of Mäori women smokers had quit in the 12 months prior to the survey (ie, the latent quit rate for Mäori women)

• to measure what proportion of Mäori women smokers were planning to quit smoking and to determine the actual success rate of this (three-month follow-up of those wanting to quit)


• to determine how respondents (ie, those currently quit and those wanting to quit) achieved their quitting goal (eg, formally or informally – through a programme, with or without Nicotine Replacement Therapy, etc)

• to describe respondents, in terms of their demographic profiles, health profiles and smoking/quitting histories.

1.3 The survey method

1.3.1 Sampling and recruitment

Identifying Mäori households:

• To identify Mäori women, a sample was drawn from the New Zealand Electoral Roll.106 From these lists a sample of people who were recorded as Mäori was randomly drawn from both rolls. Both Mäori men and women were selected. Mäori men were selected on the basis that they may be in households where there were Mäori women living also. We did not specifically sample for Mäori women at this stage. We identified a sample of households in which there was at least one Mäori adult.

Recruiting Mäori women within these households:

• As telephone numbers are not provided in the Electoral Rolls, the sample was then tele-matched using Telecom’s telephone directories.

• Prior to contacting households by telephone an introductory letter was sent out explaining the source of the contact details, giving potential respondents the opportunity to correct the telephone details and briefly outlining the research without giving away the precise topic (the research was described as ‘A survey to help improve services for Mäori women’).

• Upon contacting Mäori households by telephone, the interviewer determined whether there were any adult Mäori women107 in the household and asked to speak to the Mäori woman whose birthday was next.

• Mäori women were asked a series of qualifying questions at the beginning of the interview to determine their smoking status.

1.3.2 Survey method

The baseline research took the form of a telephone survey. We acknowledged in choosing this design that this approach excluded Mäori women who did not live in households with telephones, but the cost of conducting the interviewing on a face-to-face basis was considered prohibitive and well outside the budget available.

106 The General Electoral Roll and Mäori Electoral Roll were made available to the evaluators after the evaluators made

an application to the Electoral Enrolment Centre to use the lists for health research purposes. 107 That is, 15 years and over.


Over 4500 Mäori women were contacted and through a series of screening questions a total of n=411 full interviews were conducted. Details of the proportion of non-smokers and smokers out of the 4500 women contacted were recorded for analysis purposes. Full interviews were completed with two groups of Mäori women smokers:

• Those who were currently quit smoking. This included those who had quit in the previous 12 months and remained quit or those who were trying to quit and had not had a cigarette in the last week (n=168).

• Those wanting to quit smoking. They were currently smoking (or had quit within the last seven days) and indicated they were motivated to quit smoking in the three months following the interview (n=242).

The interviews were conducted from BRC’s centralised, fully-supervised telephone interview centre between 12 June 2000 and 12 July 2000, and were approximately 10–15 minutes long. Interviewers were fully trained and specifically briefed about using the semi-structured questionnaire designed to capture the information required. At the beginning of the interview and following the screening questions, respondents were given the opportunity to be interviewed by Mäori interviewers, although interviews were carried out in English. For those eligible to complete the full interview for the baseline survey (ie, more than the screening questions to ascertain smoking status, intent to quit), a response rate of 68% was achieved. The questionnaire included questions on the following topics:

• Screening questions to identify smokers who were currently quit and wanting to quit, who were not using the Aukati Kai Paipa pilot programme. Those on other smoking cessation programmes were eligible for the survey. (Note that the screening questions queried potential respondents about a number of social activities and behaviours so that they were not aware that the topic of the survey was smoking at the onset of the interview.)

• Quitting history (including number of attempts to quit ever/in the past three years, length of last quit, reasons for attempt and reasons for relapse to smoking, what support or aids were helpful in the previous quit attempt, use of Nicotine Replacement Therapies or cessation programmes, whether they paid for the product or not, whether free access to the products would have made it easier or no difference to their quit attempt, use of the Quitline service).

• Smoking history (including type [cigarettes, cigar, etc], amount, time until first cigarette after waking up, confidence in staying quit/quitting, smokers in household, partner’s smoking status, age started smoking, years smoking).

• Demographic information (household size, children in household, age, gender, ethnicity, employment status, educational qualifications, community services card holder status).

The three-month follow-up survey was completed with those who indicated that they were smoking but wanting to quit, to check their smoking status after three months. These


interviews were conducted between 12 August 2000 and 1 October 2000 and were approximately 5–10 minutes long. In total, n=146 interviews were conducted and a response rate108 of 94% was achieved. This second interview contained many of the same questions as the first interview, including quit status, current tobacco consumption (those not quit), support in quit attempts, quitting aids that were useful (including whether they used Nicotine Replacement Therapy or Quitline).

2 Findings of the baseline research

2.1 Latent quit rate The table below indicates the smoking status of Mäori women contacted in the baseline survey.

Baseline survey

n= %

Not interviewed:

Non-smoker/ex-smoker quit more than 12 months before 3169 70.3(a) Aukati Kai Paipa participant 13(c) 0.3

Smoker, want to quit not sure when/in more than 3 months 612(c) 13.5

Smoker, not planning to give up 302(c) 6.7

Interviewed:

Currently quit (quit in 12 months prior to call) 168(c) 3.7(b) Trying to quit now/wanting to quit within the next 3 months 242(c) 5.3

Total number of Mäori women contacted 4506 100.0

From this table the following can be determined:

a) 29.7% (28.1–31.3%) of Mäori women contacted (ie, the inverse of 70.3%) indicated that they were smokers/recently quit smokers109

b) 3.7% (3.0–5.4%) of Mäori women contacted indicated that they had quit in the previous 12 months and were currently quit

108 That is, 94% of those able to be contacted after a three-month period took part in the survey. 109 In total, 44% of Mäori (aged 15 or over) smoke, while 24% of the total New Zealand population (aged 15 or over)

smoke (Ministry of Health 1999).


c) that is, the self-reported latent quit rate, over a 12-month period, for the female, adult Mäori population is 12.5% (10.7–14.3%) (ie, 168 currently quit110 out of 1337 Mäori women smokers/recently quit smokers contacted).111 This is the proportion that should be considered when the relative effectiveness of a cessation programme for Mäori women is being discussed.

In a similar investigation on the quitting rates from smoking among adult New Zealanders over one year, Laugesen and McClellan reported that 12% of smokers had quit within the 12 months prior to the 1996 survey, for a period of one to 12 months. This was the same as the rate in 1991. The same proportion of Mäori and non-Mäori smokers had quit. The smoking rate reported by Mäori women who participated in the baseline survey is lower than that reported in the New Zealand 1996 census, for Mäori. This is similar to the finding of Laugesen and McClellan (Laugesen and McClellan 1999) who noted that fewer ‘current smokers’, and more ‘ex-smokers’ and ‘never smokers’112 were identified in the telephone survey data they analysed than were identified by the 1996 census. Laugesen and McClellan commented that this was probably due to a greater quitting success among those who own telephones or who agreed to participate in the telephone survey. This may hold true for the baseline survey too.

2.2 Profile of baseline survey participants – Mäori women quitters not on Aukati Kai Paipa 2000

2.2.1 Data presentation

The baseline survey data is presented showing those who were currently quit at the time of the survey and those wanting to quit. 2.2.2 Demographic/environmental profile

• All participants in the baseline survey were Mäori females.

• Most respondents (68%) were between 20 and 50 years of age, with the average age being 37 years.

• Almost all respondents (81%) had between two and five people living in their household.

• Close to a third (29%) of respondents had one or more child under five in their household.

• Half (54%) of respondents were waged (self-employed 6%, full-time employed 28%, part-time employed 20%).

110 The term ‘currently quit’ includes those who have given up smoking in the last 12 months, who are not currently

smoking (have not had a cigarette in the last week). 111 ‘Smokers contacted’ = Aukati participants + smoker, want to quit not sure when/in more than three months +

smoker, not planning to give up + currently quit (quit in 12 months prior to call) + trying to quit now/wanting to quit within the next three months.

112 Those who had never smoked cigarettes.


• Over a third (38%) had no school examinations, a further third had School Certificate (23%) or sixth form (10%) as their highest qualification.

• Nearly half (47%) had a community services card. 2.2.3 Smoking environment

• Over a third of respondents (38%) lived with at least one other regular smoker. Another large group of respondents (43%) was the only regular smoker living in their household. Respondents who were currently quit at the baseline survey were less likely to live with other smokers (19% lived with one or more smokers compared with 51% for those wanting to quit).

• Many respondents (36%) had a partner who was a current smoker. Respondents wanting to quit were more likely than those currently quit to have a partner who smoked (42% wanting to quit compared with 26% currently quit).

2.2.4 Smoking/quitting history

• Most, but not all, respondents started smoking before they were 20 years old (28% started under 15 years old, 53% started 15–19 years old).

• Most respondents had been smoking for 10 years or more. Almost a third (28%) had smoked for 10–19 years, and 29% for 20–30 years. Again this is similar to Aukati Kai Paipa 2000.

• Most respondents had attempted to stop smoking completely some time in the past (95%).

• Most respondents had attempted to stop smoking completely in the past three years (91%), and most had attempted to quit either once (36%) or twice (25%) during this time.

• While most respondents quit for longer than two days, almost a third of all respondents (29%) only stopped smoking for less than one week the last time they quit. Only 8% of respondents indicated that they had quit for longer than 12 months during the previous three years.

• Most of those who had tried to stop in the past, had stopped because of specific health reasons (72%) or money (34%). Reasons presented by those currently quit and those wanting to quit were similar. Some of the most common issues for quitting were:

Pregnancy.

For the sake of the health of other family members.

Just wanted to quit – realised how bad it is for you, and had had enough, need to improve general health.

Seeing others die from smoking-related causes.

Pressure from others, especially children.

Needing to become a role model for others, especially family members.

Warned by doctors to stop.


Short of breath, unfit when trying to do everyday kind of stuff.

Too expensive, especially considering recent price increases.

Overall appeal not good (eg, constantly smelling like smoke, looking haggard, etc).

Don’t like having to smoke outside.

• Reasons reported for relapse tended to be stress (46%), peer pressure (30%) or habit (19%). The peer pressure that impacted on people came in many different forms (eg, simply being around people who smoke and being tempted by them, being given cigarettes by them or feeling like an outcast being around them if not smoking). Having workmates who smoked was difficult.

Lack of willpower, weakness.

Addicted to nicotine, cravings too strong to deny, the smell alone is enough to make one start again.

Depression, irritability, moodiness when not smoking.

Relieve boredom.

Socialising – when you go out drinking you need a cigarette to go with it!

Habit – subconsciously smoking.

Fidgeting – need something to do with your hands.

Weight gain. 2.2.5 Current tobacco consumption

For those wanting to quit:

• Respondents who were wanting to quit tended to smoke cigarettes (61%) rather than rollies (39%).

• Of those who smoked tailor-made cigarettes, most smoked 10 or fewer cigarettes per day (64%). Of those who smoked rollies, nearly half smoked 10 or fewer rollies per day (55%).

• About half of those wanting to quit had their first smoke of the day either between 31–60 minutes after waking (21%) or after 60 minutes (36%). Others, had their first smoke of the day within five minutes of waking (13%) or between 6–30 minutes of waking (26%).

2.2.6 Access to quitting aids and services • The majority of respondents (92% currently quit and 87% wanting to quit) had never

used a formal programme to help them stop smoking.

• Nicotine Replacement Therapy was not widely used by respondents; 20% had used it during their previous quit attempts.

• Most people who had accessed services or cessation products had to pay to see a GP (8%) to use services, and/or paid full price for Nicotine Replacement Therapy products (70%). About two-thirds of those who paid to access cessation services and


products (65%) thought it would have been much easier if the service or products had been free.

• Quitline was not used extensively either (10% used it in their attempts at quitting). Note that this survey was carried out before Quitline started to provide Nicotine Replacement Therapy (nicotine patches and gum).

• The small group who had accessed Quitline did so to obtain a quit pack for themselves (76%) and/or had wanted to talk to someone about quitting (41%).

• Only about a third of respondents (29%) had talked to health professionals about their smoking, breathing or heart in the three months prior to the baseline survey.

2.2.7 Confidence in quitting

• Respondents who were currently quit were confident in their ability to remain quit following the baseline survey. Over half (51%) said they would definitely be able to remain quit, while a further 37% were more than reasonably confident they could remain quit.

• Most of the respondents wanting to quit smoking in the three months following the baseline survey (79%) had some confidence that they would be able to stop. However, there was a group (21%) who were not confident in their ability to stop in the ensuing three months.

2.3 Three-month follow-up (those wanting to quit) Quit success at three months:

• Eleven percent (n=16) of the respondents who took part in the three-month follow-up survey were quit at that time.

• A third (n=4) of those respondents quit at the three-month follow-up survey had been quit for the entire time since the baseline survey. A further n=7 had been quit for one month or more (but less than three months).

Confidence in staying quit:

• The majority of respondents quit at three-month follow-up (63%) indicated they would definitely be able to remain quit.

Those not quit had attempted to stop smoking:

• Over half of respondents not quit at three months (63%) had given up smoking for longer than two days following the baseline survey. However, most of those had done so for less than one week (54%).

Tobacco consumption remained steady for those not quit:

• Those not quit were smoking virtually the same quantities of cigarettes/rollies and were as addicted to tobacco as they were at the time of the baseline survey.


3 Baseline survey

3.1 Demographic/environmental profile – baseline survey

Table 84: Smoking/quit status

Q3 Could you please tell me, which one of the following best describes you in terms of tobacco smoking?

Mäori women quitters not on Aukati Kai Paipa 2000 total

n=411 %

Currently quit 41

Wanting to quit 59

Total 100


Table 85: Age

Mäori women quitters not on Aukati Kai Paipa 2000 Q27a And, how old are you now?

Total n=411

%

Currently quit n=168

%

Wanting to quitn=243

%

Under 20 13 17 11

20–30 21 23 19

31–40 26 23 28

41–50 21 18 23

51–60 12 10 14

61–70 5 7 4

71–80 1 1 0

Don’t know/refused 0 0 0

Total 100 100 100


Table 86: Number of people living in household

Mäori women quitters not on Aukati Kai Paipa 2000 Q24a How many persons, including yourself, babies, children and boarders, live in your household? Total

n=411 %


%


%

One 3 4 3

Two 22 21 22

Three 20 23 19

Four 20 20 19

Five 19 16 20

Six 6 7 6

More than six 8 10 9

Total 100 100 100



Table 87: Number of under-five-year-olds in household

Mäori women quitters not on Aukati Kai Paipa 2000 Q24b And how many of these are under five years old?

Total n=411

%


%

Wanting to quit n=243

%

None 72 74 70

One 23 22 23

Two 3 2 3

Three 2 1 2

Four 1 1 1

Total 100 100 100


Table 88: Working status

Mäori women quitters not on Aukati Kai Paipa 2000 Q28 At present, are you ...?

Total n=411

%


%


%

Self-employed 6 7 6

Full-time salary- or wage-earner 28 26 30

Part-time salary- or wage-earner 20 21 19

Retired 4 7 3

Fulltime home-maker 16 14 17

Student 12 18 8

Unemployed 3 2 5

Other beneficiary 10 5 12

Total 100 100 100



Table 89: Current occupation

Mäori women quitters not on Aukati Kai Paipa 2000

Q29 And what is your current/previous occupation? Sub-sample*

Total n=217

%

Currently quit n=91

%


%

Clerical or sales employee 24 24 23

Semi-skilled worker 14 15 13

Technical or skilled worker 7 7 7

Business manager or executive 4 5 2

Teacher, nurse, police, other trained service worker 24 21 25

Professional or senior government official 2 1 2

Labourer, manual, agricultural or domestic worker 27 26 27

Total 100 100 100


* Note: Includes only those in paid employment and those who are retired.

Table 90: Highest educational qualification


Q30 What is your highest educational qualification?

Total n=411

%


%


%

No school examinations 38 35 40

School certificate 23 20 24

Sixth-form qualification 10 10 10

School qualification higher than sixth form 3 5 2

National certificate, New Zealand certificate, trade certificate 9 11 8

Polytechnic/university course below bachelors degree 11 13 10

Bachelors degree 4 2 5

Degree higher than bachelors degree 2 3 1

Other tertiary 0 0 0

Refused 0 1 0

Total 100 100 100



Table 91: Community services card-holders


Q31 Do you have a community services card?

Total n=411

%

Currently quitn=168

%


%

Yes 47 43 49

No 53 56 51

Don’t know 0 1 0

Total 100 100 100


3.2 Smoking environment – baseline survey

Table 92: Regular smokers in household


Q24c Including yourself, how many people living in your household are regular smokers?

Total n=411

%

Currently quitn=168

%


%

None 20 47 1

One 43 35 47

Two 27 14 36

Three 7 2 11

Four 3 2 3

Five 1 1 1

Total 100 100 100


Table 93: Partners’ smoking status


Q25 If you have a partner (eg, husband/wife/de facto), which of the following describes your partner’s smoking status? Your partner may not necessarily live with you. Total

n=411 %

Currently quitn=168

%


%

Have no partner 19 18 19

They’ve never smoked regularly 23 29 19

They’re a past smoker 22 26 19

They’re a current smoker 36 26 42

Don’t know 0 0 0

Total 100 100 100



3.3 Smoking/quitting history – baseline survey

Table 94: Age at which you became a regular smoker


Q27 Firstly, could you please tell me how old you were when you became a regular (‘regular’ = smoke daily) smoker? Were you older than 15, 20, 25 years etc? Total

n=411 %


%


%

Under 15 28 28 27

15–19 53 50 55

20–29 16 19 15

30–39 2 2 2

40–50 0 0 1


Total 100 100 100


Table 95: Years of being a regular smoker


Q27b How many years have you been a regular smoker? You may have stopped and started.

Total n=411

%


%


%

Under 10 27 34 22

10–19 28 26 29

20–29 27 22 30

30–39 11 10 11

40–49 7 7 7

50–59 1 1 0


Total 100 100 100



Table 96: Number of attempts to stop smoking ever


Q7a Now, I would like to ask some more questions about you and smoking and about trying to quit. In total, how many times have you tried to stop smoking completely? This includes both successful and unsuccessful attempts.

Total n=411

%

Currently quitn=168

%


%

No attempts 4 0 7

One 16 21 13

Two 22 24 21

Three 20 20 21

Four 8 7 8

Five 7 9 6

Six or more 21 19 23

Refused 1 1 1

Still don’t know 0 0 0

Total 100 100 100


Table 97: Number of attempts to stop smoking in the past three years


Q7b And, how many times in the last three years have you tried to stop smoking completely?


%

Currently quitn=168

%


%

No attempts 11 8 14

One 36 43 32

Two 25 26 24

Three 11 13 10

Four 4 2 5

Five 3 1 4

Six or more times 9 9 10

Total 100 100 100


* Note: Only those who have tried to stop smoking completely in the past.


Table 98: Number of successful attempts to stop smoking completely


Q8 Thinking about the last time you tried to stop smoking completely, were you able to stop for more than two days?


%


%


%

Yes 86 92 82

No 13 8 17

Can’t recall 1 1 0

Total 100 100 100



Table 99: Length of time been able to stop smoking


Q9 How long were you able to stop for? Sub-sample*

Total n=393

%


%


%

Up to 7 days 30 16 41

1 to 2 weeks 14 12 15

3 to 4 weeks/1 month 14 15 15

2 months 6 8 4

3 months 8 9 7

4 to 6 months 12 19 5

7 to 12 months 8 11 4

1 year 5 7 4

2 years 3 4 3

3 years 1 0 1

15 years 1 1 0

Can’t recall if more than two days 1 1 0

Total 100 100 100




Table 100: Reasons for quit attempt


Q10 What were the reasons you tried to stop smoking?


%

Currently quitn=168

%


%

Health 72 70 74

Money 34 29 37

Other 41 45 37

Total 100 100 100



Table 101: Reasons for relapse

Q11 What was the main reason you started smoking again?

Sub-sample*

Mäori women quitters not on Aukati Kai Paipa 2000 wanting to quit

n=225 %

Stress 46

Peer pressure 30

Habit 19

Weight gain 6

Other 23

Don’t know 2

Total 100



3.4 Tobacco consumption – baseline survey

Table 102: Types of tobacco smoked the most

Q17 Which one of the following types of tobacco do you smoke the most?

Sub-sample*


n=243 %

Cigarettes 61

Tobacco/roll your own 39

Total 100


* Note: Includes only those wanting to quit in three months following the baseline survey.


Table 103: Tailor-made cigarettes smoked per day within the last week

Q18a Over the last week, about how many cigarettes have you smoked per day?

Sub-sample*


n=148 %

1–10 64

11–20 28

21–30 7

31 or more 0

Total 100


* Note: Includes only those wanting to quit in three months following the baseline survey, who smoke tailor-made cigarettes.

Table 104: Rollies (roll your own cigarettes) smoked per day within the last week

Q18b Over the last week, how many rollies have you smoked per day?

Sub sample*


n=96 %

1–10 55

11–20 33

21–30 8

31 or more 0

Total 100


* Note: Includes only those wanting to quit in three months following the baseline survey, who smoke rollies.

Table 105: First cigarette after waking up

Q19. How soon after you wake up do you have your first cigarette? Sub-sample*


n=243 %

Within 5 minutes 13

6–30 minutes 26

31–60 minutes 21

After 60 minutes 36

Don’t know/depends 4

Total 100


* Note: Includes only those wanting to quit in three months following the baseline survey.


3.5 Access to quitting aids and services – baseline survey

Table 106: Use of formal programmes in the last year


Q4 [Those currently quit] Did you or have you used a formal programme to help you quit smoking? By programme, I mean a formal programme that has been given to you by your GP, counsellor or quit coach.

Q5 [Those wanting to quit] In the last year, have you used a programme to help you quit smoking?

Currently quitn=168

%


%

Yes 8 13

No 92 87

Total 100 100


Table 107: Quitting aids and services that have been helpful


Q12a What were all the things that really helped you when you were trying to quit?


%

Currently quitn=168

%


%

Getting support from friends/whänau/work-mates 61 64 58

Cutting back on number of cigarettes per day before quitting 57 43 68

Drinking lots of water 52 51 52

Chewing gum (not nicotine gum) 46 41 49

Exercise 46 46 46

Nicotine patches/gum/spray/inhalers 20 14 24

Herbal cigarettes/Nicobrevin113 12 11 14

Quitline 10 5 14

Other programmes 1 1 2

Don’t know 2 2 2

Nothing 26 29 24

Total 100 100 100



113 Nicobrevin is a non-nicotine cessation product.


Table 108: How accessed cessation services and products (payment for access)


Q13a When you used these products did you ...? Sub-sample*

Total n=100

%

Currently quit n=34**

%

Wanting to quitn=66

%

Pay full price for the products 70 59 76

Pay to see a GP 8 12 6

Pay a subsidised amount for the products 7 12 5

Get products for free from a GP, clinic or health service 6 3 8

Get products given to you by family or friends 18 29 12

Don’t know/no response 2 3 2

Other 2 0 3

Total 100 100 100


* Note: Includes only those who used an NRT product or non-nicotine product like Nicobrevin.


Table 109: Whether free access to products and services would have made difference


Q13b If this product and service was free would it have made quitting easier or not? Is that ...?


%

Currently quit n=24**

%

Wanting to quitn=54

%

Much easier 65 54 70

A little easier 8 13 6

It would have made no difference 27 33 24

Total 100 100 100


* Note: Includes only those who had to pay for the NRT, pay to see a GP.



Table 110: Using the 0800 Quitline


Q14a When you used the 0800 Quitline, did you ...? Sub-sample*

Totaln=41

%

Currently quitn=9**

%


%

Talk with the advisors to try to quit 41 22 47

Talk with quit advisors about smoking/cutting back/other things 29 11 34

Get a quit pack sent out for someone else 7 11 6

Get a quit pack sent out for yourself 76 89 72

Don’t know 5 0 6

Total 100 100 100


* Note: Includes only those who indicated they had used the Quitline when trying to quit.


Table 111: Contact with Quitline advisor


Q15 About how recently did you talk with a Quitline advisor?

Sub-sample* Totaln=22**

%

Currently quitn=2**

%

Wanting to quit n=20**

%

In the last week 14 50 10

In the last month 14 50 10

In the last three months 9 0 10

In the last three to six months 23 0 25

More than six months ago 41 0 45

Total 100 100 100


* Note: Includes only those who talked to a Quitline quit advisor.

** Caution: low base number of respondents—results are indicative only.

Table 112: Contact with health professionals about smoking, breathing, or heart, within the last

three months


Q16 In the past three months have you talked to your GP, practice nurse, a chemist, or any other health professional about your smoking or anything to do with your breathing or your heart?

Sub-sample*

Totaln=393

%

Currently quitn=168

%


%

Yes 29 23 34

No 71 77 66

Don’t know 0 0 0

Total 100 100 100




3.6 Confidence in quitting/staying quit – baseline survey

Table 113: Confidence in quitting/staying quit


Q20 [Those wanting to quit] On a scale of 1–7 how confident are you that you can stop smoking in the next three months? (1 being ‘I won’t be able to do it’ to 7 being ‘I’ll definitely be able to stop’).

Q22 On a scale of 1–7 how confident are you that you will stay quit? (1 being ‘I won’t be able to do it’ to 7 being ‘I’ll definitely be able to stop’).


%


%

I won’t be able to do it (not confident) 1 8

2 0 3

3 2 10

I should be able to do it 7 20

5 20 25

6 17 11

I’ll definitely be able to stop (very confident) 51 22

Don’t know 1 1

Total 100 100


4 Three-month follow-up of those wanting to quit

4.1 Getting support from others – three-month follow-up

Table 114: Support received from others

Q17 Now, thinking about the people you live with, your friends and whänau, overall how supportive have they been while you were trying to quit smoking?

Total after three months n=146

%

Not quit after three months

n=130 %

Quit after three months n=16*

%

Very supportive 40 35 75

A bit supportive 19 20 13

Neither supportive nor unsupportive 22 24 6

A bit unsupportive 7 8 0

Very unsupportive 6 6 6

Don’t know 6 7 0

Total 100 100 100




Table 115: Whether quit with others

Q19 Did anybody try to stop smoking with you (eg, partner, friend, brother ...)?


%


n=130 %


%

Yes 32 32 31

No 68 68 69

No response 1 1 0

Total 100 100 100



Table 116: Who respondents quit with

Q20 Can you please tell me who it was? Sub-sample*

Total after three months n=46**

%


n=41** %

Quit after three months n=5**

%

Friend 26 24 40

Partner/husband/boyfriend 37 39 20

Parent/son/daughter 20 17 40

Brother/sister 11 12 0

Cousin/aunt/uncle 4 5 0

Workmate/colleague 4 5 0

Whänau 7 5 20

Other 7 7 0

No response 2 0 20

Total 100 100 100


* Note: Only those who stopped with someone else.


4.2 Success in quitting/cutting back – three-month follow-up

Table 117: Whether quit since last spoken to

Q3 Since you were last interviewed have you been able to stop smoking for any length of time?


%


n=130 %


%

Yes 40 33 100

No 60 67 0

Total 100 100 100




Table 118: Current quit status

Q4 Are you currently quit? Sub-sample*


%


n=43** %


%

Yes, for two days or more 36 12 100

Yes, for less than two days 3 5 0

No 61 84 0

Total 100 100 100


* Note: Only those who were able to stop smoking.


Table 119: Whether have occasional puffs

Q5 Do you still have a few occasional puffs?

Sub-sample*


%


n=5** %


%

Yes 24 100 0

No 76 0 100

Total 100 100 100


* Note: Those that were able to quit for more than two days.


4.2.1 Those quit at three months

Table 120: Length of current quit

Q6 How long have you been quit? Sub-sample*


%

Up to 1 week 13

2 weeks or more 6

3 weeks or more 0

4 weeks/1 month or more 25

2 months or more 19

3 months or more 31

4 months or more 6

5 months or more 0

Total 100


* Note: Those currently quit (ie, quit after three months).



Table 121: Confidence in staying quit

Q7 On a scale of 1–7 how confident are you that you will stay quit?

Sub-sample*


%

I won’t be able to do it (not confident) 6

2 0

3 6

I should be able to do it (reasonably confident) 0

5 6

6 13

I’ll definitely be able to do it (very confident) 63

Don’t know 6

Total 100


* Note: Those currently quit (ie, quit after three months).


4.2.2 Those not quit at three months

Table 122: Whether quit for any length of time

Q9 At any stage have you given up smoking for a period longer than two days any time since we last surveyed you?

Sub-sample*

Not quit after three months n=38**

%

Yes 63

No 37

Total 100


* Note: Those not quit.



Table 123: Length of time quit

Q10 How long did you stop smoking for? Sub-sample*


%

2 days 4

3 days 8

4 days 8

5 days 4

6 days 17

7 days 13

8 days 8

14 days 13

21 days 4

1 month 13

2 months 4

Total 100


* Note: Those who had been able to stop smoking for two days or more.


Table 124: Reason for relapse to smoking

Q11 What was the main reason you started smoking again? Sub-sample*


%

Habit 21

Peer pressure 13

Other 42

Refused 25

Don’t know 4

Total 100


* Note: Only those that relapsed back to smoking after attempting to stop


4.2.3 Tobacco consumption (those not quit)

Table 125: Reduction in tobacco consumption

Q13 Are you smoking less now than you were last time we interviewed you?

Sub-sample*

Not quit after three months n=125

%

Yes 52

No 48

Total 100




Table 126: Current tobacco consumption – cigarettes

Q15a Over the last week, about how many cigarettes have you smoked per day?

Sub-sample*


%

1–5 14

6–10 22

11–15 13

16–20 7

21–25 1

No response 42

Total 100



Table 127: Current tobacco consumption – rollies

Q15b Over the last week, about how many rollies have you smoked per day?

Sub-sample*


%

1–5 10

6–10 15

11–15 5

16–20 7

21–25 2

26–30 2

No response 59

Total 100



Table 128: Time to first cigarette after waking

Q16 How soon after you wake up do you have your first cigarette?

Sub-sample*


%

Within 5 minutes 20

6–30 minutes 22

31–60 minutes 16

After 60 minutes 42

Total 100




4.3 What helped in the quit attempt? – three-month follow-up

4.3.1 Aids to quitting

Table 129: Aids to quitting – all

Q21a What were the things that really helped you when you were trying to quit?

Total after three months

n=146 %


n=130 %

Quit after three months

n=16** %

Getting support from friends/whänau/workmates 28 28 31

Exercise 12 12 6



Cutting back on number of cigarettes before quitting 5 6 0



Don’t know 1 1 0

Nothing 16 16 13

Other 75 75 81

Total 100 100 100



Table 130: Aids to quitting – most helpful

Q21b What was the most helpful? Sub-sample*


n=122 %


n=108 %


n =14** %

Getting support from friends/whänau/workmates 13 12 21

Exercise 7 8 0




Cutting back on number of cigarettes per day before quitting 2 2 0


Don’t know 1 1 0

Other 67 67 71

Total 100 100 100


* Note: Those who found something helpful.


114 Nicobrevin is a non-nicotine cessation product. 115 See Footnote 114.


Table 131: Use of Nicotine Replacement Therapy and other aids

Q22 When you used products like nicotine gum, patches, spray or inhaler or any other non-nicotine based products such as Nicobrevin, or herbal cigarettes, which ones did you use?

Sub-sample*


n=34** %


n=31** %


n=3** %

Nicotine gum 21 23 0

Nicotine patches 50 52 33

Nicotine spray 9 6 33

Nicotine inhaler 21 16 67

Nicobrevin (a non-nicotine cessation product) 29 29 33

Don’t know 3 3 0

Other 12 13 0

No response 3 3 0

Total 100 100 100


* Note: Those that used cessation aids.


4.3.2 Use of Quitline service

Table 132: Use of Quitline service

Q23 When you used the 0800 Quitline, did you ...? Sub-sample*


Talk with quit advisors to try to quit 21

Talk with quit advisors about smoking/cutting back/other things 37

Get a quit pack sent out for someone else 21

Get a quit pack sent out for yourself 79

Total 100


* Note: Those who contacted the Quitline service.


Table 133: Recency of using Quitline service

Q24 About how recently did you talk with a Quitline advisor? Sub-sample*


%

In the last month 25

In the last 3 months 25

In the last 3–6 months 25

More than 6 months ago 25

Total 100


* Note: Those that talked to a quit advisor at the Quitline service.



Appendix F: Personnel Involved in Aukati Kai Paipa 2000 Pilot Programme Ngati Whatua o Orakei Health Services: Angilla Perawiti, Karla Clay, Karla Armstrong, Te Aroha Pihama, Simon Perawiti, Rina Stewart, Jan Heath, Ann Blundell, Naomi Tongiauelu, Grant Hawke

Kokiri Marae Hauora: Teresea Olsen, Cheryl Davies, Marina Kirikiri, Leah Clark, Tamihana Nuku, Jacky Maaka, Keriana Kingi, Tama Tua, Sarah Tumai, Maria Henderson, Gaynor Rikihana

Te Hauora o te Hiku o te Ika: Desley Austen, Jo Davis, Frances Dromgool, Tiffany Masters, Rosemary Pocklington, Carmen Popota, Phyllis Shepherd, Maureen Allan

Papaharakeke Maori Health Consultancy: Marewa Glover

Novartis Health Consumer: Joe O’Neill

ATAK: Shane Bradbrook

HSC: Anaru Waa, Trevor Shailer

Hauora Whanui o Ngati Hine: Maxine Shortland, Sharna Tangira, Kopa Tipene, Mano Paraha, Christine Henare

Te Runanga o Kirikiriroa: Jackie Sowerby, Awhi Reid, Marcia McCord, Donna Heu, Pania Roa Watene, Mavis Walters, Lesley Tarrant

Poutiri Trust and subcontractors: Emma Campbell, Maude Takarua, Te Araroa Potene, Irene Walker

Ngai Te Ahi Hauora: Yolande Tipuna, Raewyn Walker

Te Runanga O Ngai Pikiao: Sheryldeen Iraia

Te Wairua o te Ora: John Hape

Te Whare Hauora o Ngongotaha: Maata Teariki, Julie Fraser, Liz Te Aonui

Waitangi Medical Centre: Ngaire Dinsdale, Rose Clark, Angela Dinsdale

Te Whare Maire: Hinehou Campbell, Della Tai, Te Ao Kurei

Te Hauora Matauraka: Tahupotiki Stirling, Megan Ellison, Fleur Bridger, Sarah Lee Te Huki Evaluation team:

Te Pümanawa Hauora: Chris Cunningham, Annemarie Gillies, Sharon Taite, Frances Te Kani, May Collins

BRC Marketing & Social Research: Anne Dowden, Emanuel Kalafatelis, Greta Yardley, Bridget Gilhooly. Many of their colleagues also provided invaluable support to these teams.

evaluation of culturally appropriate smoking cessation

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