Smoke, smoking and cessation - Asthma Foundation New Zealand

Smoke, smoking and cessation: The
views of New Zealand children with
respiratory illness
Dr Marewa Glover
Anette Kira
Julienne Faletau
Centre for Tobacco Control Research
School of Population Health
Poverty, poorly informed, poor
provision of asthma medicines
Asthma is a worldwide
public health problem
affecting about 300 million
World Health Organisation
recognises asthma as a
leading NCD, the poor
management of which is
undermining achievement of
the Millennium Development
Consequences of smoking on
respiratory conditions
• Māori have higher risk of dying from respiratory
diseases and have higher rates of hospitalisation and
death than non-Māori
Source: Robson, B., & Harris, R. (Eds.). (2007). Hauora: Maori Standards of Health IV. A Study of the Years 2000-2005. Wellington: Te
Popu Rangahau Hauora a eru Pomare
Consequences of exposure to
Exposure to smoking during pregnancy increases the risk
• Respiratory response to low oxygen levels in the
• Respiratory infection
• Chronic bronchitis, wheezing, lower respiratory tract
• Any asthma
Secondhand smoking increases the risk of
• respiratory problems
• lung cancer
Why this study?
• Need to urgently reduce smoking among Māori
and Pacific Island parents of asthmatic children
• Need to understand more about children’s
exposure to SHS (identified as a research need in
the Governments response to the Māori Affairs
Select Committee’s Report on tobacco).
• No research investigating NZ children’s
perceptions of parents’ smoking
• Aim: to explore the attitudes of Māori and Pacific
children with respiratory illness towards second
hand smoke (SHS), smoking and parental smoking
• 27 Māori and 13 Pacific children (6-11yrs) were
interviewed (7 individually, 34 in focus groups)
• They were asked:
– attitudes towards smoking
– how SHS affects them
– fears and concerns about smoking for themselves and
their parents
– how to reduce their exposure to smoking
– their experience asking parents to quit smoking
• Interviews were transcribed, entered into NVivo
and analysed using a deductive approach
• SHS made them feel “bad”, “angry”,
“uncomfortable”, and “really sick”, making
them want to get away from the smoke.
• They were aware that smoking “is dangerous”
and that “you could die from it”.
“If you smoke too much you’ll
have to go to the hospital and
get your body fixed”
Results - Fears
• Children expressed fear for their mother or
father or other family members who smoked.
“They might get cancer and die and we’ll feel
“and we won’t have parents to
look after us”.
Results – SHS Exposure
• Beliefs of effect of secondhand smoking exposure.
• The children appeared to extrapolate the potential
ill-effects of direct smoking to bystanders exposed
to secondhand smoke.
“it could’ve got in her… face and then she could’ve
got sick… and could’ve died” (8yr Māori M).
“The boy might not breathe… like stop breathing…
cause the smokes are coming into his nose” (8yr
Tongan M).
Results – Children’s own
• Children mentioned that being around smoking
gave them a “tight chest” (8yr Māori F),
“headaches” (10yr Māori F), it made them cough
and smoke made it difficult for them to breathe.
“It made my asthma bad and then I coughed hard”
“It makes you can’t breathe… and then you have to
go to the doctors”
Result – Reducing SHS Exposure
“I usually just go away”
• Some children talked about asking smokers to not smoke around them,
for example one child says to smokers
“you’re not allowed to smoke around me cause I have asthma”
• Other children did not feel they could talk to smokers, or when they
did the response was dismissive or ineffectual.
• Many of the children believed that there were rules against smoking
around children or indoors.
“you’re not allowed smoke in the car where babies are” (11yr Tongan M)
Result – Experience with Adult’s
smoking cessation
• Many children had experience with people around them quitting :
“Mum has tried to give up smoking and she has. So it’s really changed my
life. So it’s changed everyone’s”
• Many children expressed positive feelings when someone had
managed to quit smoking:
“This time they [mum and dad] have stopped [smoking]. So I gave them a
high five. I felt very happy and very proud of them” (6yr Māori F).
Some children appeared to be aware that “smoking is hard to stop”
one child said about his mother who “started again ... But she can’t help
Result – Ideas for reducing
Children’s suggestions for how to increase adult cessation:
“talking to them [smokers]”
“say please can you stop smoking… because they [the parents] might die”
“… you give me asthma”
• A number of children said to “hide all the smokes away”. However, they also
expressed trepidation about doing that:
“Last time when I saw my aunties pick her cigarettes, I was like should I pick them up
and put them in the bin, and I was like oh nah she might give me a growling”
• Children also suggested
– showing the smoker a “pamphlet of the lungs [affected by smoking]”
– “put a sign”
– “sticker that says no smoking”
– “write a letter to the Prime Minister of NZ, John Key (10yr Māori F) asking him
why he won’t ban smoking”.
• The children’s beliefs about the effects of smoking were
quite fatalistic, lacking an understanding of risk – the
message they receive is not “smoking increases the risk
of cancer” but that “if you smoke you will get cancer”.
• Despite their relatively powerless position in the family
to do anything about adults smoking, the children still
wanted to help people who smoked to stop.
• The most common suggestion for reducing smoking
prevalence and exposure to SHS was to appeal to
What can be done?
• The children supported policy measures restricting
smoking in certain areas.
• Health providers and tobacco control providers need
to be careful of encouraging ‘pester power’ and need
to consider how to enable children to act on their
fears for smokers in their life without increasing
children’s risk of abuse.
• It would be safer for stop smoking campaigns to be
the voice of the children.
What can be done?
• Health providers could tell parents that children have
deep unspoken fears that their parents are going to
• Give a clear consistent message to parents to stop
• And provide support to quit or referral to a smoking
cessation service.

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