National Health Committee Guidelines for Smoking Cessation Launch

  • Georgina te Heuheu
Associate Minister of Health

Royal New Zealand College of General Practitioners and Practice Nurses Conference
Thank you for the invitation to join you here today.

Smoking remains the major preventable cause of ill health and premature death in New Zealand, but happily its something that we can do something about.

We can achieve significant improvements to the health of New Zealanders, indeed this is an area of potential health gain.

The launch of these "Smoking Cessation Guidelines" today offer a very practical and positive way for you to reinforce the importance of the non-smoking message.

As health professionals you have a very important role in the health of our nation. These guidelines provide a sensible and straightforward approach to assist people to give up smoking .

The way in which you introduce these guidelines in to your day to day practices will have a significant impact. I urge you to take these on board.

I would like to take the time to acknowledge all of those involved in the drafting of these guidelines. It was a diverse group convened by the National Health Committee and chaired by the Heart Foundation's Boyd Swinburn. It included, the Royal College of General Practitioners, Smokefree Coalition, the Cancer Society, Auahi Kore, Pegasus Medical Group, Health Funding Authority, Te Hotu Manawa Maori, a consumer representative and various other health professionals.

Smoking is an issue for all New Zealanders. Sadly it is a particular issue for Maori women. I am pleased to hear that the drafting of these guidelines involved extensive input from Maori.
The advice in the guidelines will be highly relevant.

Stopping people from starting to smoke in the first place is important. However anything that can support existing smokers to give up is also vital.

Since 1996 we have introduced a number of initiatives as part of a smokefree strategy to reduce smoking by young people.

These include:
· the Why Start? multi media advertising programme,
· an increased focus on banning the sale of cigarettes to minors,
· more smokefee sponsorship of sporting and cultural events
· more smoke free schools programmes,
· the increase of cigarette buying age from 16 to 18 years,
· the banning of kiddies packs or ten cigarette packs and the ban of the sale of single cigarettes

Recent figures on youth smoking rates released this week by the Ministry of Health suggest that this smokefree strategy may be starting to work.

The survey showed that between 1997 and 1998 statistics have began decline by eight percent, although the smoking rates for fourth formers had still increased overall since 1992. Even if these figures are decreasing the uptake of smoking is far too high. Its not good enough.

Another study also released this week by the Health Services Research Centre showed strong links between where people live and the chances of being a smoker. The study's researcher Dr Peter Crampton named one reason for this as the contagion effect - that people who live among smokers have far more reason to be smokers.

I'm encouraged that a number of our Marae have gone smoke free but those people who have yet to quit can still do practical things to provide a smokefree environment for others by not smoking in public places, or around our children.

In the past few months the government has introduced a range of initiatives to help smokers quit. The Prime Minister, Jenny Shipley, launched the national 'Quitline' on 6 May 1999 and this week, at the Public Health Association conference here in Wellington, Associate Minister of Health Tuariki Delamere launched a television advertising campaign to publicise the Quitline.

These guidelines are the latest initiative to assist and support New Zealanders to give up smoking.

Your actions in implementing these guidelines will make things better in reducing smoking - not only for all New Zealanders but particularly for Maori.

I am sure that more than half of all Maori health problems would be solved if Maori stopped smoking. You are at the forefront of that objective because in the end helping Maori benefits all of us. Healthy people can benefit the whole country.

The good news documented in these Guidelines is that even brief smoking cessation advice from health professionals significantly improves quit rates.

In addition, there are a number of evidence-based interventions that improve the chances of successfully quitting. For example, the use of nicotine replacement therapy as an adjunct to counseling and organised follow-up.

Smoking cessation is a dynamic process and takes place over time rather than as a single event. Smokers cycle through the stages of contemplation, quitting and relapse an average of three to four times before achieving permanent success.

Given the range of effective interventions outlined in the Guidelines, both health professionals and smokers can be confident that the prospects are excellent for eventually quitting successfully.

Success in quitting depends less on any specific type of intervention than on delivering personalised smoking cessation advice. For example if a patient is considering quitting you could say, "As your nurse/doctor I strongly advise you to stop smoking". The key to cessation will be in repeating personalised advice in different forms from different sources over a period of time. Repeat those messages often!

The use of these new Guidelines will help ensure that health professionals systematically and consistently deliver smoking cessation advice in four simple steps - the 4 'A's: Ask, Advise, Assist and Arrange.

First, as health professionals you should systematically ask about and document the smoking status of every adult.

Health professionals should then advise smokers about quitting at nearly every encounter by providing brief cessation messages. For some groups, such as teenagers, positive reinforcement of continued abstinence is also worthwhile. We all respond to encouragement.

Third, people with some interest in quitting should be assisted to do so. You can provide them with information on support options such as the Quitline and nicotine replacement therapy.

Finally, health professionals should arrange follow-up for smokers ready to quit. Check on their progress. Congratulate and encourage them.

In conclusion, helping people to quit smoking remains one of the most important and cost-effective interventions that health professionals can undertake.

These Guidelines for Smoking Cessation bring together research that shows what is effective, important information on support options, and a systematic process - the four A's - to help people quit smoking. I applaud this initiative to develop the guidelines that will assist us to achieve important health gains for all New Zealanders.

I have already acknowledged the critical role you and indeed all the health providers around the country play in fighting this battle. Once again I would like to give my support to all of you here today.

New Zealanders are now starting to take ownership of the problem. These guidelines are another important step to support the personal battle against smoking that many people face.

I have much pleasure in launching them.
Thank you.