MANU AO SEMINAR TOBACCO CONTROL FOR MĀORI TE TOHU ME TE TAURANGI - GEORGE LAKING MD PHD FRACP MEDICAL ONCOLOGIST AUCKLAND DHB; - MASSEY UNIVERSITY

MANU AO Seminar
        Tobacco Control for Māori
        Te Tohu Me Te Taurangi
          George Laking MD PhD FRACP
         Medical Oncologist Auckland DHB;
Trustee, Te Hotu Manawa Māori; Treasurer, Te ORA

            06 Whiringa-a-Nuku 2010

UK Universities Superannuation Scheme
1 HSBC BANK                  545.5
2 ROYAL DUTCH SHELL          501.2
3 VODAFONE GROUP             392.7
4 BP                         340.3
5 GLAXOSMITHKLINE            312.4
6 BHP BILLITON               258.5
7 RIO TINTO                  252
8 ASTRAZENECA                222.7
9 BRITISH AMERICAN TOBACCO   200.3
10 BG GROUP                  184.3
11 TESCO                     173.1
12 BARCLAYS                  170.3
13 ANGLO AMERICAN            168.8
14 STD CHARTERED             162.2
15 UNILEVER (UK)             141.8
16 LLOYDS BANKING GROUP      140.2
17 DIAGEO                    132.3
18 IMPERIAL TOBACCO          129.2
19 RECKITT BENCKISER         118.2
20 NESTLE R                  108.9

New Zealand Tobacco Action Network
                 (NZTAN)
 The online tobacco control community in NZ
 Administered by ASH, www.ash.org.nz
 Membership ~ 250
 Used daily by the tobacco control community
   Academics / NGOs / Providers /
    Te Hotu Manawa Māori
    Te ORA Māori Medical Practitioners' Association
    Department of Public Health, University of Otago, Wellington
    Centre for Tobacco Control Research, University of Auckland
    ASH / Smokefree Coalition / Roopu Me Mutu

$106M

                                          $10.5M

                                          $0.65M

1.3 billion users, > 14500 deaths a day

www.moh.govt.nz   www.hauora.maori.nz

Māori Smoking and Tobacco Use
 Median age of Māori smoking initiation = 11.7
 Current smokers
      –  46% of all Māori, 21% of all non-Māori
 Wāhine Māori who smoke
     –  49% (highest prevalence of any group)
     –  in 25-29 agegroup almost 4x greater than non-Māori
 Lung cancer deaths
     –   31% of cancer deaths in Māori, vs 17% in non-Māori
 Contributes to 7-8 year LE gap
     –   2.3x higher cardiovascular death rate
     –   2.6x higher respiratory death rate

Māori Smoking and Tobacco Use
 Parents who smoke
      –   ~50% in Māori, ~20% in non-Māori
 Roll-your-own tobacco use
      –   73% of Māori smokers
 ↓ Daily smoking among Māori
      –   2002/03: 47%; 2006/07: 38%
 >11700 Māori Registered with a quit service
      –    e.g. Quit Group’s Quitline, web service and Txt2Quit .
      –    after accessing Quitline services, 18% Māori quit
 Annual Māori tobacco excess mortality ~650

If nobody smokes tobacco from 2020 onwards, we estimate
additional gains in life expectancy for Māori ranging from 2.5
to 7.9 years (average 4.7) and for non-Māori ranging from 1.2
to 5.4 years (average 2.9).
Going smokefree as a nation by 2020, compared to no change
from the 2006 Census population smoking prevalence, will
close ethnic inequalities in life expectancy by 0.3 to 4.6 years
(average 1.8 years; consistently greater for females).
NZMJ 13 August 2010, Vol 123 No 1320

Van Gogh, Skull with Burning Cigarette, 1886

Interpretation of the Evidence. The association of lung cancer with cigarette smoking is
    generally agreed to be true but various possible explanations of this association other
    than that of cause and effect have to be considered. These are
(para. 32) :–
(i) that people who are going to get lung cancer have an increased desire to smoke
    throughout their adult lives:
(ii) that smoking produces cancer only in the lungs of people who are in any case going to
    get cancer somewhere in the body, so that smoking determines only the site of the
    cancer:
(iii) that lung cancer affects people who would have died of tuberculosis in former times
    but have now survived with lungs susceptible to cancer:
(iv) that smokers inherit their desire to smoke and with it inherit a susceptibility to some
    other undiscovered agent that causes lung cancer:
(v) that smokers are by their nature more liable to many diseases, including lung cancer,
    than the “self-protective” minority of non-smokers:
(vi) that smokers tend to drink more alcohol than non-smokers so that drinking and not
    smoking may cause lung cancer:
(vii) that motor car exhausts, or – (viii) that generalised air pollution may render the lungs
    of smokers more liable to cancer.
None of these explanations fits all the facts as well as the obvious one that smoking is a
    cause of lung cancer.

“We cannot hope to win in a head-on
confrontation. Our tactics must be to
discover our opponents weaknesses,
attack those particular points, cause
as much confusion as possible, and
attack somewhere else while their
attention is distracted.”
Philip Morris, 1978

Traditionally, epidemiology has been used to identify
associations that point to possible causes of a disease,
providing direction for thorough laboratory investigations.
With smoking, the many laboratory investigations over the
years have proved more problematic, and science has not
to date been able to identify biological mechanisms which
can explain with certainty the statistical findings linking
smoking and certain diseases, nor has science to date
been able to clarify the role of particular smoke
constituents in these disease processes.
                                               www.batnz.com

Hanahan & Weinberg, The Hallmarks of Cancer, Cell, 2000

TUPEKA

Agent                  Structure   Chemistry              Cancer

Polycyclic aromatics               Alkylating agent       p53 dna adducts anti-
(benzopyrone)                                             apoptosis
                                                          (Denissenko, Science
                                                          1996)

Acrolein                           Glutathione depletion, Favours proliferation
(propenal)                         oxidative stress       (Kehrer, Toxicol. Sci.
                                                          2000)

Nitrosamines                       Alkylating agents      DNA adducts, strand
                                   (Arimoto-Kobayashi,    breaks,
                                   Mutat Res 2007)        anti-apoptosis

TUPEKA

Agent            Structure   Chemistry                Cancer

Arsenic                      Thiol-affinity of        Mutagenicity,
                             As(III) oxides;          proliferation
                             oxidative stress         (Kitchin, Chem Res Toxicol
                                                      2010)

Nicotine                     Nicotinic AchR;          Growth,
                             Nitrosation (Sleiman,    Anti-apoptosis
                             Proc Natl Acad Sci USA   (Lee, JNCI 2010)
                             2010)

Smoke (n.o.s.)               Plasminogen              Addiction, Growth,
                             activator                Metastasis,
                                                      (Du, Cancer Res 2007; Nagai,
                                                      J Pharm Sci 2008)

“Of all the concerns, there is one –
taxation – that alarms us the most.”
Philip Morris, 1985

D O'Dea and G Thompson

Estimated prevalence elasticity for smoking of –0.20: so 20% price rise
causes 4% relative fall in prevalence, e.g. absolute fall from 50% to 48%

Million cigarette consumption in 4th quarter of FY
     2008: 757
     2009: 405.5

Ngā Mahi Kaupapa Māori

Manaakitanga
Whānaungatanga
Rangatiratanga
Kotahitanga
Kaitiakitanga
Maramatanga
Wairuatanga

To increase the number of Māori smokers
   who make evidence based, supported quit
   smoking attempts,
by doubling the number of Māori who have
   access to nicotine replacement therapy
   and support, immediately and at no cost;
In the home / In the workplace / In schools.
Awhi Mai Awhi Atu
Aukati Kaipaipa
Taonga puoro (porotiti)

National Māori Tobacco Control Service

 Steering Group – stakeholder networks
 Tobacco sector scoping exercise
 Communications plan
 Strategic plan to align with
   – Māori Affairs Select Committee recommendations
   – Whānau Ora processes.

georgel@adhb.govt.nz