Understanding parental influences on smoking uptake among Māori children: A mixed methods investigation

Smoking is a leading cause of preventable death world wide. In New Zealand reducing smoking rates is an important public health issue, particularly among Māori where smoking rates are almost double that compared to non-Māori. Public health interventions over recent years have focused on increasing smoking cessation. However, less attention has been paid to reducing smoking uptake. Many people transition through the stages of smoking uptake as children and parents can play a significant role in preventing this. However, relatively few models have been developed to fully understand how parents can influence the smoking uptake process, particularly in relation to Māori. The purpose of this thesis was to explore and identify causes of smoking uptake for Māori youth, with a focus on how they relate to parental behaviours and the broader whānau context. Methods: A mixed methods approach was used to identify parental influences. Methods used were a literature review, quantitative analyses of two large youth smoking surveys and qualitative key informant interviews with parents and caregivers of Māori children. Findings from the studies were synthesised to develop a model that attempted to explain pathways of parental influence on smoking uptake for Māori children. These influences were organised in relation to those behaviours that can socialise children to take up smoking and more general parenting behaviours. Findings: Parental smoking socialisation behaviours for Māori youth were related to anti-smoking expectations, exposure to smoking behaviour prompts, anti-smoking attitudes and engaging in anti-smoking discussions with children. Contrary to prevailing evidence, quantitative findings suggested that parental smoking was not an independent risk factor for smoking uptake. More general parenting behaviours were poor parent-child relationships (including communication), lack of monitoring of a child’s behaviour, and lack of reinforcement of rules or expectations with children. Whānau and parenting vaules such as manaaki (caring), whānaungatanga (connecting with family) and love and support are potential motivators for parents to take action to reduce the risk of their children starting to smoke. A key finding was that identity as Māori was not found to be an independent risk factor for smoking behaviour among children. Therefore, an explanation for higher rates of smoking uptake among Māori youth is that they are more likely to be exposed to known risk factors. Conclusions: Findings from this thesis have two important implications for practice. First, interventions should seek to address known risk factors for smoking uptake but be appropriate for Māori. Second, interventions should address general parenting behaviours as well as smoking specific behaviours