Māori Women Benefit From a Harm Reduction Approach to Smoking

    Smoking rates among Indigenous peoples have remained stubbornly high around the world, despite stigmatizing anti-smoking campaigns and massive increases in cigarette taxes. In New Zealand, a pack of cigarettes now costs the equivalent of almost $25 US.

    Māori women are one of the most socially deprived groups in New Zealand, and have the highest smoking rate of any demographic there, at 36 percent. Pregnant Māori women are 35 percent more likely than the general pregnant population to be smokers. Māori men also smoke at a high rate of 31 percent.

    Te Piki Oranga, a Māori primary health provider, offers a harm reduction-based quit-smoking program called Te Hā (The Breath). It’s designed for and targeted to the Māori, Pacific Islanders, pregnant women of any ethnicity, and other vulnerable populations.

    Te Hā offers nicotine gum, patches, lozenges and vaping devices free of charge—including a first vape pod, although participants later buy their own—which is a crucial feature for vulnerable populations of smokers surviving on low incomes.

    The program defines success not only as quitting smoking altogether, but also by measures such as reducing the number of cigarettes smoked, or simply saving money. And it has been successful on these terms.

    According to project leader Sonia Hepi-Treanor, more than 70 percent of participants have quit entirely or cut down on cigarettes smoked per day. “Ultimately you would like them to quit tobacco altogether, but that is a journey and as a quit coach, we walk alongside the client, keeping the mana (power) of the person you are supporting intact throughout the support,” she told Stuff.

    That smokers find switching to vaping relatively easy shouldn’t be surprising. The hand-to-mouth gesture, inhalation and exhalation are powerfully reinforcing and enjoyable.

    Of 100 participants surveyed, 90 percent used vaping devices to try to quit smoking or cut down. Hepi-Treanor thinks that vaping is popular because it replicates the rituals of smoking as well as providing the nicotine that means people don’t have to go “cold turkey.” She helps each person select the correct amount of nicotine so they don’t go into withdrawal.

    A 71-year-old woman in the program, who has been tobacco-free for one year, said she would “never have quit smoking if I didn’t have the vape.” A couple who also quit smoking a year ago report spending only one-third of the weekly amount on vapes that they previously did on cigarettes.

    That smokers find switching to vaping relatively easy shouldn’t be surprising. For decades smokers have told researchers that the hand-to-mouth gesture, inhalation and exhalation are powerfully reinforcing and enjoyable. It’s one reason why nicotine patches and gums have such a low success rate: The ritual is gone.

    A just-published Cochrane Review has affirmed that smoking quit rates are higher for people who vape nicotine than for those who use traditional nicotine replacement therapy (NRT).

    Te Hā wants all participants to quit vaping within a year, however. “I talk about how vaping is a tool to quit smoking tobacco,” Hepi-Treanor said, “and then they need to also look into quitting vaping eventually.” But it is a mistake to put a time limit on vaping. There will be vapers who will decide to maintain their use of nicotine indefinitely, and that’s okayit’s harm reduction. A crucial reason some might want to continue using nicotine is for the many benefits of the drug, including an increase in focus and attention and its relaxing effects.

    Most countries have essentially given up on lowering the rates of smoking among vulnerable populations.  New Zealand has not. Te Hā has demonstrated that vaping helps Indigenous people with the highest rates of smoking to quit. Vaping products should be an option in all quit-smoking programs that serve them.



    Photograph by Lindsay Fox/EcigaretteReviewed.com via Wikimedia Commons/Creative Commons 2.0

    • Helen is Filter‘s senior editor and a multimedia journalist. She is on the methadone, vaping and nicotine train. Helen is also a filmmaker. Her two documentaries about methadone are Liquid Handcuffs and Swallow THIS. As an LCSW, she has worked with people who use drugs for over two decades. Helen is an adjunct assistant professor and teaches a course about the War on Drugs at NYU. She lives in Harlem.

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