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In a doctorate study on Maori smoking cessation behaviour, Te Whare Tapa Wha, a contemporary Maori paradigm was used as the theoretical framework for analysing smoking behaviour. One hundred and thirty Maori smokers aged 16-62, who were intending to quit were interviewed prior to their quit attempt and on average four months later. Physical aspects of smoking behaviour, such as, smoking history variables and number of cigarettes smoked per day were grouped under te taha tinana. Variables, such as, participants' beliefs about their reasons for smoking, motivation and intention to quit were grouped under te taha hinengaro. Social and familial factors that influenced participants' smoking are discussed under te taha whanau and data pertaining to actions or beliefs about the effects on and the role of wairua are discussed under te taha wairua. The results show how the application of Te Whare Tapa Wha to the problem of smoking supports the need for holistic approaches to intervention. Smoking cessation interventions, for instance, need to combine treatment of nicotine dependency with cognitive behavioural therapy, whilst targeting the whole whanau. Attending to te taha wairua should improve effectiveness for Maori. Public health policies and programmes, such as a strong Smokefree Environments Act and frequent exposure to smokefree media campaigns, help create a supportive environment for change.
Tobacco smoking is the biggest killer of Maori people, killing about 440 annually based on 1989-93 Maori deaths (Laugesen & Clements, 1998). Maori have the highest death rates from coronary heart disease in the OECD group of countries and Maori women have the highest rate of lung cancer in the world and suffer cervical cancer at more than twice the national rate (22.4 vs. 10.4 per 100 000 annual average 1993-95) (Ministry of Health, 1998). High rates of smoking among Maori women during pregnancy (two thirds of Maori women smoke during peak child rearing age) (Glover, 2004), contributes to higher rates of miscarriage, preterm births, low birth weight babies and other difficulties during childbirth (Pomare, Keefe-Ormsby, Ormsby, Pearce, Reid, Robson, & Watene-Haydon, 1995). In 1996, the Maori Sudden Infant Death Syndrome rate was around five times higher than that of non-Maori (4.6 vs. 0.9 deaths per 1000 live births) (Ministry of Health, 1998). From birth, Maori record proportionately higher...