Almost one out of two young Maori women in their 20s are smokers, with 48 per cent lighting up.
Research revealed Maori girls are three times more likely to be daily smokers than either girls or boys of other ethnicities.
Dr McElnay said material deprivation income, overcrowding and material attributes all collected from the Census showed there were also consistently more smokers in lower socio-economic areas.
"Smoking is the biggest cause of health inequity."
In deprived areas, as many as 30 per cent of people are smoking, while in more affluent areas the numbers drop as low as 5 per cent.
One finding in her research was particularly shocking -- the number of pregnant women who continue to smoke.
The difference with pregnant smokers was the impact of the smoking, she said.
"It's not just the health effect on the mother but the effects on the unborn baby. Ultimately changing smoking patterns is about changing behaviour for something that is highly addictive." Dr McElnay said.
"At the end of the day to change behaviours you have to want to change."
The nappy incentive scheme is an example of a programme that does encourage people to stop smoking by providing that extra bit of motivation.
This scheme gives mothers free nappies if they show a commitment to quit smoking.
"Pregnant women smoking is a public health crisis and we need to do something about it," she said.
The DHB has identified Maori women, especially those in low decile areas, as a key target.
"We are setting ourselves a challenge to be more innovative."
Hawke's Bay currently has an eight-year gap of life expectancy between Maori and non Maori.
"We are particularly concerned about this and it is something we are trying to focus on," Dr McElnay said.
"Because it is an addiction, some people find it easier to stop than others. Some can do it by themselves, others need an incentive programme or replacement therapy.
"Education is enough for some people while the draw of the nicotine is too much for others."
She had no definitive figures on the cost smoking has on the health sector but said it was a huge drain on funds.
"We haven't costed per se but there is a huge cost from heart disease because of the number of smokers who develop heart disease.
"They spend a number of years managing their disease, which is a huge cost to the health sector."
However, the most significant negative health outcome of smoking was lung cancer, with Hawke's Bay recording a high mortality rate.
"What we invest we will see returned from the benefits of preventable ill health and mortality."
Dr McElnay understands the challenge of being a smokefree region.
"When we talk about New Zealand's target of being smokefree by 2025 that's not 0 per cent, what we are aiming for is 5 per cent, which is a realistic target."
New Zealand's leading cessation service Quitline believes the smokefree target for 2025 is achievable with increased efforts to help smokers quit and stay that way.
A Quitline spokesman said that in 2006, 20.7 per cent of New Zealanders smoked - seven years later it was down to 15.1 per cent.
That meant there were 26,714 fewer smokers each year.
"A focus on better cessation support is important for the Smokefree 2025 goal but we also need to think about creating the right environment to help the person quitting smoking," Dr McElnay said.
Of all New Zealand smokers, two-thirds expressed regret at having started smoking in the first place.
Habit keeps burning bigger holes in wallets
Tobacco use in 2015 is hurting smokers in the wallet as much as it is the lungs and heart.
The price for a pack of cigarettes has increased by around 1100 per cent in the last 30 years.
Smoking continues to be by far New Zealand's single leading cause of avoidable death and disease.
With huge tax increases on cigarettes the average price of a pack of 20 cigarettes is now more than $20.
The tax has increased by 40 per cent in the past four years.
In 2011, the average price of a pack of 20 cigarettes was $14.40 and a 30g pouch was $25.50.
Today, a 25 pack of Rothmans will run you $28.50 and a 20 pack Benson and Hedges $22.20, the cheapest option being Freedom at $19.20.
A Hastings resident told Hawke's Bay Today he bought his first home in 1985 for about $60,000. That would equate to 34,285 packs of cigarettes.
Today at $20.90, 34,285 packs would cost $716,000. That would be three first homes.
In 1985 the average weekly wage was $320 which would have bought you 185 packs of cigarettes. Today the average weekly wage of $1,100 will buy you just 52 packs. A Big Mac would cost you more than a pack of smokes in the mid 80s.
Today you can buy about four Big Macs for the cheapest brand of cigarettes.
Smokefree Communications Manager Sarah Woods said when the price goes up it is the tipping point for people who are already thinking about quitting.
"Smokers need to think about their behaviour and changing it.
"For example most people would smoke with a coffee in the morning so changing that can help."
Although some people are never going to change.
Local check out operator Sarah, who asked that her real name be withheld, said the rise in cigarette prices had not deterred her from her pack-a-day habit.
"I'm addicted and when you're addicted the cost is kind of irrelevant," she said.
