Why Smokefree?
Tobacco smoking is a major public health problem in New Zealand, overall around 23% of New Zealanders smoke tobacco (21% in South Canterbury). Tobacco smoking is directly linked to almost 5,000 deaths each year causing significant morbidity and contributes to inequalities in health in New Zealand; therefore tobacco smoking is New Zealand's largest preventable cause of death (MOH, 2007).
Stopping smoking confers significant immediate and future health benefits especially in those who already have smoking-related diseases. Helping people who smoke to stop is therefore a leading health goal and should be viewed as a life saving intervention for them and their families. Reducing harm from tobacco is identified as a key health target and is integral to the management of chronic disease; CVD risk reduction, cancer risk reduction and management of COPD amongst others (SCDHB, 2005), (MOH, 2007).
Maori Perspective
Prior to European arrival, Maori culture was Auahi Kore (smokefree). Smoking amongst Maori today is contrary to Maori traditions and Tikanga (customs). Becoming Auahi Kore (smokefree) is to give oneself and whanau the opportunity to gain wellbeing, spiritually and physically. Nearly 50% of all Maori smoke and have a greater mortality rate due to smoking and smoking related illness.
Pacific Peoples Perspective
Like Maori, Pacific peoples were smokefree and smoking is contrary to traditions and customs. Pacific peoples in New Zealand have a high smoking prevalence rate of 36%, 39% males and 33% females.
Systematic Approach
Addressing smoking offers unparalleled opportunities to improve the health status of smokers and their families/whanau: - this is the nature of smoking and the scale of health improvements that can be gained when smokers quit.
Achieving a positive impact on patients' smokefree status will occur more readily and consistently if the whole healthcare sector is geared up to the smokefree agenda. Smokefree initiatives are clinical initiatives, not just environmental or regulatory.
Clinical Intervention
Guidelines for approaching smoking with patients are based around a simple three step - A B C approach:
- A - Ask about smoking status
- B - Give Brief advice to stop smoking to all people who smoke
- C - Provide evidence-based Cessation support for those who express a desire to stop smoking
Approximately 22% of smokers will want to quit at any one time (MOH, 1999). indeed 30% do try each year (West R, Getting serious about stopping smoking, 1997).
Intervention starts with assessment. It is vital that all smokers have their status established - this ensures that brief interventions can occur and help can be offered. This may be particularly important with patients in high risk groups, infrequent attendees and non enrolled patients. Brief Intervention by doctors has been shown to increase smokers quit rates significantly (OR 1.69; Silagy,2002).
Consistently establishing smokers' current status and offering brief advice will begin to lead patients to discussions around making changes in their smoking. Consistent advice or an offer of assistance to stop smoking is clinically effective in helping smokers to stop smoking. (NNT 40 -Smoking Cessation Guidelines, 2007).
The best approach is summarised by Fiore et al, in the US Clinical Practice Guidelines. 2000:
A little and often by many over time.
Doctors , midwives, some nurses and others can provide Quit Cards for NRT.
NRT is of proven value in assisting smokers to stop. NRT is safe and effective in aiding smoking cessation. It approximately doubles the chances of long-term abstinence
(Silagy C, et al. 2006. Cochrane Database quoted in Smoking Cessation Guidelines, 2007).
Additionally, the offer of referral for smoking cessation support may be appropriate as these also greatly increase success rates. (Smoking Cessation Guidelines, 2007). There are many avenues available locally.
Most smoking cessation services are free or highly subsidised. Some services will actually supply free Nicotine Replacement (NRT) while those services using Quit Cards will cost patients only $15 - $20 for eight weeks supply of subsidised NRT. Services can also work to support smokers who are quitting without medication as well as those who may be using prescribed medications such as Nortriptyline, Bupropion (Zyban) or Varenicline (Champix).
Prescribing NRT
Doctors can prescribe Nicotine Replacement Therapy (NRT) on standard prescription pads. Other health professionals, e.g. dentists, opticians, midwives and nurses will continue the supply of NRT through the Quit Card scheme.
Prescriptions for NRT can be made for up to 8 weeks treatment i.e.
8 boxes of Patches & Gum or 12 boxes of Lozenges.
Patients will be asked to make a $3 co-payment for funded NRT products when issued against a prescription or Quit Card.
For advice from Pharmac, click here
Information & Education Resources
The MoH e-learning module on smoking cessation is designed to enable any registered health professional to provide advice and access to NRT for their patients / clients.
This module can be completed online and is certificated (providing evidence of one hour of professional development). Click on the link below to enter the site:
ABC Smoking Cessation e-learning Education Website
NZ Smoking Cessation Guidelines 2007
These guidelines provide the definitive guidance regarding smoking cessation. Heavily revised from the 2002 edition, these guidelines give advice concerning different treatment options for different treatment groups.
NZ Smoking Cessation Guidelines 2007
- Other useful websites are listed below:
A useful resource for Dentists, is the "Helping Smokers Stop - A Guide for the Dental Team" publication from the NHS Health Development Agency (Now part of NICE), & British Dental Association UK, (2004) at NICE.
Sources of Support & Advice in South Canterbury
SCDHB - smokefreedom
Smokefreedom South Canterbury is a free specialist smoking cessation service, provided by South Canterbury DHB, operating at Timaru Hospital and in the community. The team are able to provide specialist smoking cessation services to your patients / clients, including specialist support for pregnant women, or those planning to start a family and mental health service consumers, whether in hospital, at home or through community health services and groups.
The team is based at Timaru Hospital and can assist and advise about using NRT to manage withdrawal symptoms for inpatients as well as providing continued support and Quit Cards for NRT in the community.
You can make referrals by phone, email or FAX. Our service is free of charge to our clients.
Professional Advice and Training
The smokefree team can provide advice to all healthcare practitioners concerning any smokefree issues. We are able to provide awareness training, Brief Intervention training and deliver the MoH "ABC of Smoking Cessation" training package which can enable health professionals to become Quit Card providers in their own right,
Contact Details:
Phone: (03) 684 1491
TXT: 027 205 5460
Fax: (03) 684 5273
Email: smokefree@timhosp.co.nz
Smokefree Team, Timaru Public Hospital, Private Bag 911, Timaru 7940
Aukati Kaipaipa
Aukati Kaipaipa is a free smoking cessation programme specifically for Maori and Whanau (family) delivered in a culturally appropriate manner.This is a free service providing Nicotine Replacement Therapy with one on one counselling support and follow up delivered by Maori quit coaches over a twelve month period. Referrals are accepted from any healthcare professional.
Aukati Kaipaipa can provide advice to healthcare professioanls about raising the issue of smoking with Maori and offering culturally appropriate care.
Contact Details:
Koriana Waller
Phone: (03) 684 0666
Cell: 027 226 0356
Email: koriana.waller@cdhb.govt.nz
Aukati Kaipaipa, Community and Public Health, 6B Sefton St, PO Box 510, Timaru 7940
Visit the Aukati Kaipaipa Website
Community & Public Health (C&PH)
Community and Public Health provides public health services to more than 555,000 people living in the Canterbury, South Canterbury and West Coast regions, and is a division of the Canterbury District Health Board, serving as the Public Health Unit (PHU) for these three regions.
C&PH can provide smokefree / auahi kore health promotion advice, information and resources. They provide assistance with implementation of the Smokefree Environments Act, promoting smokefree environments such as homes, cars and playgrounds. They also host the Aukati Kaipaipa service for South Canterbury .
Contact Details:
Phone: (03) 688 6019
Fax: (03) 688 6091
Community and Public Health, 6B Sefton St, PO Box 510, Timaru 7940
Visit the Community & Public Health Website
Aoraki PHO
Smokefree Primary Care Resource
The Smokefree Primary Care Manual was developed in 2007, in partnership with the SCDHB Smokefree team, Aukati Kaipaipa and Community & Public Health. It contains useful information about policy, systems, resources, use of medications and details of all local smokefree services.
Note:- It is currently being updated.
Contact Details for Aoraki PHO:
Phone:(03) 687 2031
Fax:(03) 684 9092
Email: aoraki_enquiries@aorakipho.org.nz
Aoraki Primary Health Organisation, 18 Woolcombe Street, PO Box 208, Timaru 7940
Visit the Aoraki PHO Website
For a general list of smokefree organisations and workers, you can access the:
Smokefree Auahi Kore Directory
For a & location map of smokefree services in South Canterbury, click here 