Ka Wai Ola - Office of Hawaiian Affairs, Volume 25, Number 6, 1 Iune 2008 — Cultural sensitivity lights up anti-smoking conference [ARTICLE+ILLUSTRATION]

Cultural sensitivity lights up anti-smoking conference

By Liza Simon Public Affairs Specialist Sometimes Leimomi Shearer helps smokers kiek the habit by advising them to wait until they are ready to quit. She knows what this means. A smoker from age 12, she tried quitting a dozen times - but eould not. Then she heeame the Caneer Program Coordinator with Hawai'i Island's Native Hawaiian Heahh Care System (NHHCS). She resolved to "walk the talk of wellness," and finally discovered a tobacco-cessa-tion medication that worked for her. Now she finds that she has energy for eanoe paddling and her smoke-free life is just better in general. But as exemplary as her experience has been, the Native Hawaiian Hilo resident doesn't hold it up as a model for other Native Hawaiians who eome for heakh assessments at NHHCS. Mostly, she listens to their experiences. "Compassion and empathy are the main skills needed for anyone working in tobacco cessation," said Shearer. "My major thing is I don't want people to set up an unrealistic goal for themselves and then they fail. There is nothing worse than feeling like a failure." Shearer's sensitivity may seem like an unlikely weapon to combat the tobacco industry's expenditure of more than $24 million per day to advertise and market its deadly and addictive products. But at a firstever tobacco use prevention eonference recently held in Honolulu specifically for Native Hawaiians and Pacific Islanders, heahh experts said more sensitivity is key in helping indigenous populations decrease their smoking rates, whieh have remained stubbornly high in spite of sweeping tobacco use prevention education funded since 1998 under a landmark Master Settlement Agreement between the tobacco industry and 46 states - including Hawai'i. "For our clients at NHHCS, smoking is very often related to difficult stressors in a other departments of a person's life, like job loss or homelessness. Smoking

becomes a coping mechanism, even with its adverse effects," said Donna-Marie Palakiko, a nurse practitioner with the NHHCS on O'ahu. "Any smoker who comes to us is inunediately given infonnation on heahh risks of cigarettes and options for quitting, but we find it works best to use a holistic approach, take time to build a relationship and address a person's overall heahh." The latest studies show that all of the state's major ethnic groups - with the sole exception of Native Hawaiians - dechned in their rate of smoking by about 10 percent over the duration of the last 20 years. Meanwhile, Native Hawaiians are down less than two percentage points from an overall rate of 29 percent recorded two decades ago. Research also shows that Native Hawaiians have the highest rates in the state for smoking-related diseases including hypertension and lung cancer. A new worldwide report on disparities in eancer suggests that indigenous Paeihe Islander populations — including Native Hawaiians, are more susceptible to the cancer-causing properties of cigarette smoke. The report is carried in the May edition of The Lancet Oncology, an international medical research journal. At the recent conference, representatives of NHHCS, a statewide healthcare for Native Hawaiians, said the grim statistics prompted the launching of a new heahh education brochure that depicts smoking as "anti-Hawaiian." On the cover of the brochure, a quote from noted Native Hawaiian physician Dr. Kekuni Blaisdell offers this insight: "Kanaka Maoli did not consume hamhul chemicals, such as tobacco and aleohol." The brochure was funded by a grant from the Asian Pacific Partners for Empowerment Advocacy and Leadership and marked an important departure from generic materials produced on the U.S. continent, said LorrieAnn Santos, a program manager for 'Imi Hale, the Native Hawaiian Cancer Network, whieh works closely with NHHCS in help-

ing to tailor tobacco prevention campaigns to Kanaka Maoli. "We want to get across the message that manufactured tobacco with ehemieal additives was introduced by colonization. As the result of oppression, our people have lost so mueh and taken up the oppressor's bad habits," said Santos. Santos and her NHHCS eolleagues gave thumbs up to a recent Hawai'i state Department of Heahh ad campaign for appealing to a sense of 'ohana with anti-smoking TV messages. In one of the TV spots, a makua says she gave up smoking, because she wanted to "live long enough to see her grandchild graduate." But media messages alone - even well targeted ones - aren't enough to end the proportionately high rates of nicotine addiction of native peoples, according to many who convened at the conference. A major challenge lies in the way smoking is entrenched in native communities. In New Zealand, for example, indigenous Maori are likely to work in low-paying industries where smoking is prevalent, said Maori tobacco prevention educator Shane Bradbrook. "So you have an overlap of several subcultures, where smoking has becomes the social nonn," said Bradbrook. Making changes to the social norm often means making laws, Bradbrook added. In response to puhlie pressure on lawmakers, the New Zealand government has now banned smoking in cars in order to protect child passengers from the proven harmful effects of second-hand smoke, he said. And the anti-smoking laws are being strictly enforced in New Zealand, said NHHCS's DonnaMarie Palakiko, who attended a New Zealand healthcare eonference last year. Palakiko also said that cigarette advertising is "subdued" in Maori conununities. By comparison, indications are that smoking in the U.S. continues to be "glamorized" by the tobacco industry. Studies show that the media messages are often aimed specifically at marginalized socio-economic groups,

including Native Hawaiians. Teens are also susceptible to ads that depict smoking as a "eool thing." Conference participants said outreach to Native Hawaiian youngsters is a top priority. In conducting a NHHCS cancer assessment study in the Waimānalo area last year, Palakiko was alarmed to find a large portion of teenage girls were tobacco users. Most, however, reported wanting to quit. "This means we have to make ourselves and tobacco cessation efforts more visihle in the Hawaiian community in order to help," said Palakiko. But visibility takes funding. And because funding from the state's share of the Tobacco Master Settlement is provided on a year-to-year basis, it is often a challenge to sustain anti-smoking programs. Nonetheless, Native Hawaiian healthcare providers say they've heeome more strategic in using available funds for tobacco interventions in the conununities they serve. One sign of progress is a

dramatic increase in the number of Native Hawaiians who work as cancer researchers from an iniīial five to 150. "This means we have (healthcare professionals) attuned to the problems affecting Native Hawaiian smokers. If they know the problems their clients face on a daily basis, they are able to gain their trust and work from there," said 'hni Hale's LorrieAnn Santos. New projects now underway with support from NHHCS and its parent agency Papa Ola Lōkahi range from research into the genetic basis of smoking-related cancer in Native Hawaiians to the development of a popular "outreach kit" on Kaua'i that awarded puka shell bracelet channs for every day that a smoker refrained from lighting up. "We have to admit it's just not easy to break this bad habit," said NHHCS' Leimomi Shearer. "I walk by my co-workers who are on smoking breaks. I miss socializing with them, but I am listed as a resource person for the loeal tobacco quit-line and so I j ust have to keep walking .' ' □

For help in quitting tobacco: Ho'ola Lāhui Hawai'i Hui No Ke Ola Pono (Kaua'i anel Ni'ihau) (Maui) 244-4647 246-351 1 www.huinomaui.org www.hoolalahui.org Huj AAālama Ke Ola Mamo 0|a Nā '0jwi (O'ahu) 845-3388 (Hawai'i) 969-9220 www.keolamamo.org www.huimala Na Pu'uwai maolanaoiwi.org (Moloka'ianā Papa Ola Lokahi Lana i) 560-3388 www.papaolalokahi.org www.napuuwai.com

OLAKINO ■ YOUR HEALĪH

Health Specialists meet to prevent problems of Pacific lslander fobacco use. Left to right: Shane Bradbrook (Maori Smokefree Coalifion-Te Reo Marama); Lorrie-Ann Santos (Imi Hale, a program at Papa Ola Lōkahi); Andrea Siu (Ke Ola Mamo, O'ahu); Leimomi Shearer (Hui Mālama Ola Nā 'Ōiwi (Hawai'i lsland); Donna-Marie Palakiko (Ke Ola Mamo, O'ahu) Pholo: Liza Simon