Smoking Prevalence and Ethnicity

Prevalence for smoking in fathers at the 11-year measurement wave (38%) was much higher than the 28% prevalence rate reported at a similar timepoint amongst Pacific males in the 2011/12 NZ Health Survey (Ministry of Health, 2012). Although the latest 2013 census statistics estimate the smoking prevalence for the NZ Pacific male population at 26% (Statistics New Zealand, 2013), our findings highlight very high levels of smoking amongst this cohort of Pacific fathers resident within the greater Auckland region. However, this is somewhat reflected in latest census statistics which highlight smoking rates being substantially higher than the national average amongst; people who live in highly deprived areas, Maori and Pacific peoples, and people with mental health disorders. Deprivation is strongly associated with smoking in NZ, and given that Pacific people are more likely to have high smoking rates and live in highly deprived areas, the results amongst Pacific fathers within this study may not be unexpected.

The high smoking prevalence rate amongst Cook Islands fathers (47%) compared to other ethnic groups is another finding of grave concern. Smoking is a significant cause of cardiovascular disease (hypertension, stroke, heart attacks), and previous research examining mortality rates for Samoan, Cook Islands, Tongan and Niuean people, reported elevated CVD mortality among Cook Islands people (Blakely et al., Reference Blakely, Richardson, Young, Graham, Tobias and Callister2009). Cook Islands people enjoy NZ citizenship and the opportunity for unencumbered migration from their traditional home islands. Consequently, they have undergone longer exposure and assimilation to NZ society compared to other Pacific ethnic groups (Ministry of Pacific Islands Affairs, 2002; Statistics New Zealand and Ministry of Pacific Island Affairs, 2010), and this decline in affinity with their Pacific traditions may make them more susceptible to engaging in risky health behaviours such as smoking (Tautolo et al., Reference Tautolo, Schluter and Taylor2011a; Reference Tautolo, Schluter, Paterson and McRobbie2011b). Similar research from Wong et al. (Reference Wong, Ameratunga, Garrett, Robinson and Watson2008) examining the influence of family and acculturation on smoking amongst Asian families in NZ highlighted a strong association between individuals with a high affinity for their traditional culture, and a lower likelihood of smoking uptake. These findings suggest a need for targeted, culturally specific approaches that prompt and support cessation amongst this Pacific population.

Motivations for Cessation

Our findings suggest a high proportion of Pacific fathers (81%) wish to quit, creating opportunities to take advantage of a motivation that already exists. Moreover, a number of Pacific fathers (82%) felt concerned about their own health and recognised their smoking may impact their children's health (50%), a finding echoed in research by Glover et al. (Reference Glover, Nosa, Gentles, Watson and Paynter2014). Previous research with this cohort identified at least half the children followed in the PIF study live in households where at least one parent smokes (Tautolo et al., Reference Tautolo, Schluter and Taylor2011a). Unless these parents proactively eliminate environmental tobacco smoke from their children's environment, or shield their children from this, a large proportion of these Pacific children are likely to be exposed to second-hand smoke and face the many risks such exposure brings (Ministry of Health, 2010).

Impact of Tobacco Tax Regulations

Alongside the impact on their own health, two-thirds (66%) of fathers wanted to quit smoking because of ‘the cost’, and nearly three quarters (74%) stated they had reduced their smoking as a result of the price increases following excise tax adjustments. These findings suggest current government legislation imposing incremental increases in excise tax for tobacco in NZ are likely to encourage Pacific fathers to at least reduce their smoking. In fact, similar research from Cowie et al. (Reference Cowie, Glover and Gentles2014) amongst socioeconomically disadvantaged groups in NZ including Pacific people, found that tobacco tax increases had not only led to a reduction in consumption but also an increased number of quit attempts. Advocating for continued tax increases is essential, and many Pacific Island countries have committed to adopting similar strategies to encourage smoking cessation (WHO Western Pacific Region & Secretariat of the Pacific Community, 2013).

However, despite strong evidence for high cigarette taxes as an effective method for reducing cigarette smoking, they can also impose a significant financial burden on low-income smokers, of which a high proportion are of Pacific ethnicity (Farrelly et al., Reference Farrelly, Nonnemaker and Watson2012; O’Dea, & Thomson Reference O’Dea and Thomson2007). Nevertheless, further research is needed to explore these underlying issues and their ongoing consequences within Pacific communities. Future research could also examine whether larger tax increases could more effectively stimulate quit attempts among Pacific fathers so that policy measures optimise the likely response from priority groups. Future studies could also examine whether messages featuring the cost savings from quitting could be targeted more specifically at Pacific fathers, and whether these would be more effective than health messages.

Developing Cessation Interventions

Health promotion programmes could use these findings in many ways. First, they could focus more specifically on fathers’ smoking, which receives less research and health promotion attention than mothers’ smoking e.g., focus amongst cessation services on pregnant women smokers as a priority for support. Future research could examine whether messages featuring personal risk and the risk posed to vulnerable family members would prompt quit attempts among Pacific fathers. Second, while family members are becoming smokefree, it will be important to protect infants and children from second-hand smoke. It is crucial that campaigns promoting smokefree homes and cars have media schedules that reach Pacific families and, ideally, use messages and role models that will resonate with Pacific fathers.

Strengths and Limitations

The PIF Study has many salient strengths, including that it follows a large birth cohort over time, it involves the family triad (mother, father and child) and it has had a relatively small attrition rate to date (Paterson et al., Reference Paterson, Tukuitonga, Abbott, Feehan, Silva and Percival2006; Reference Paterson, Percival, Schluter, Sundborn, Abbott and Carter2008). Arguably, the most important limitation of this study is the reliance on self-report of smoking, not validated by any biochemical tests. However, self-reported data on current smoking status can have high validity, demonstrated in previous research regarding the prevalence of smoking measured using self-report data (Patrick et al., Reference Patrick, Cheadle, Thompson, Diehr, Koepsell and Kinne1994). Furthermore, additional investigations have established the utility of self-report data as a reliable indicator of smoking status, particularly within population based studies (Rebagliato, Reference Rebagliato2002; Vartiainen et al., Reference Vartiainen, Seppala, Lillsunde and Puska2002). The question used in the PIF study – ‘Over the past week, how many cigarettes did you smoke on average per day?’, differs from the question used in other tobacco surveys in NZ e.g., ‘On a typical day how many cigarettes do you smoke?’ (Ministry of Health, 2009). While the PIF study question is likely to capture information on current smokers, it may not capture ‘intermittent’ or ‘social’ smokers, potentially underestimating the smoking prevalence within this cohort. Nevertheless, previous research has utilised this question (Tappin et al., Reference Tappin, Lumsden, McIntyre, McKay, Gilmour and Webber2000). In addition, the question ‘Has the recent series of tax increases (2010-projected 2012) on cigarette sales in NZ caused you to reduce your smoking?’ may be interpreted as a leading question and could potentially introduce social desirability bias within participant responses. Moreover, as there was no timeframe for the question about specific motivations to quit smoking, the respondent may be reporting on a quit attempt made some time in the past and not related to current policies and tobacco control interventions.