Long queue for the last smoke

One woman's addiction shows the problems that are facing the publicly funded Quitline. NAOMI LARKIN and ALAN PERROTT look at how hard it is to stub out a habit.

The fourth time the supportive Quitline counsellor called, something inside Catherine McDonald screamed out for a calming drag.

"I'm great thanks, I'm not smoking any more. Thanks for calling."

Then she quickly hung up, walked outside and lit a cigarette.

Catherine is one of the lucky ones who was able to reach the overstretched stop-smoking service.

But she found it takes more than a phone call to stub out that last cigarette.

The Quitline phonelines show the numbers calling out for help.

The service expected about 10,000 calls last month, but Quitline national manager Jane Mills says it has had more than 40,000.

Requests for the Government-subsidised nicotine replacement patches and gum are so high the helpline is recommending people call back in a month.

About 6000 subsidy cards, exchanged for gum or patches at pharmacies, have been sent to smokers, and 4000 callers have been put on a waiting list to be rung back by an assessor.

Ms Mills agreed the wait might mean lost quitting opportunities.

"It's very frustrating from our end that we are not able to deal with everyone."

The service is recruiting an extra 17 staff to process the backlog. Quitline now has 23 quit-smoking advisers, compared with 15 before the subsidy programme started.

The Ministry of Health is expanding the scheme to include doctors and other health workers.

But it cannot say when quitters will be able to swap their vouchers for gum and patches from supermarkets and other retailers.

Ministry spokesman Matthew Allen says the idea of having them available from retailers is new, and its development depends on the retailers.

"If they are particularly interested and want to get moving on it, then we'll move with them."

It was only recently that nicotine gum and patches had been allowed to be sold through retail outlets such as supermarkets.

Health Minister Annette King says no one could have predicted the demand for the subsidised service, and is asking people to be patient.

The Government has allocated $6.18 million a year for the programme for at least four years.

It expects that up to 40 per cent of New Zealand's estimated 750,000 smokers will be interested in it.

Director-General of Health Dr Karen Poutasi says that to help ease the demand, GPs will be able to give the free nicotine replacement therapy and the accompanying counselling within the next fortnight.

But the way GPs will be paid has yet to be worked out.

The patches and gum, worth about $125 for a one-month course, cost smokers $10.

"It's highly likely that you will pay for your general practitioner's consultation," said Dr Poutasi, "but we're working with GPs to sort out who will be in a position to qualify for being able to do the therapy, who will not and what the criteria are."



Catherine's path to Quitline began when her six year habit reached crisis point in July during a netball game.

"I found I just couldn't run around any more. Then on the way home I was having a smoke and thought what the hell am I doing?"

But going cold turkey got Catherine the cold shoulder from her workmates.

"I was a total pain and everybody got sick of months of me moaning and groaning. Eventually, they forced me to call Quitline and even stood over me as I made the call."

The 22-year-old Aucklander is still smoking, but credits the programme with reducing her from a pack-a-day girl to a weekend smoker.

She's happy with her accomplishment, but hopes she has answered her last "how are you going" call from Quitline.

"I felt like I was being treated like a child. Their attitude was all very PC (politically correct) and definitely patronising."

Jane Mills says she will look into Catherine's complaint, but hopes it is an unusual experience.

"Our advisers are nearly all ex-smokers," she said.

"They have a lot of training, and their aim is certainly to be helpful and supportive to smokers.

"We provide call-backs as long as people want them, and there is absolutely no pressure on people to be called back. If they don't want us to call, then it's no problem."

The Ministry of Health is hoping such "almost there" cases like Catherine will slide into total abstinence through pressure on their wallets.

The latest tax increase on tobacco products came into force this week.

Tobacco companies announce their price increases next week, but a packet of 20 cigarettes is expected to go up by about 30c and loose tobacco by $1 a packet.



Tobacco companies added their own increases to the 14 per cent tax rise in May, eventually delivering an average increase of 20 per cent.

While the statistics are far from certain, Matthew Allen estimates the May increase caused a seven per cent drop in consumption.

This was aided by factors such as the Quitline programme, media campaigns, and increased spending on cessation services, including an extra $5 million for Maori anti-smoking agencies.

Quitline attributed a three-fold increase in calls during May, compared with previous months, to the tobacco tax increase.

But all that effort and money will eventually go up in smoke unless people really want to give up, says on again-off again smoker Sue Fox.

The 34-year-old new mother is trying to give up for the third time.

The difference this time, she says, is that she really means it.

Like Catherine, Sue fell in with a group of puffers at school.

Her 15-year-relationship with cigarettes has included three break-ups totalling seven years.

Two years ago she tried hypnotism, "the best $150 I ever spent."

Sue is adamant putting up prices and offering patches are no replacement for willpower.

"Giving up just seemed like a good idea the first two times, but then I decided I wanted to have a baby and I decided I definitely had to stop.

"We all know it's a disgusting habit; you just convince yourself you can stop whenever you want.

"But smoking isn't just an addiction, it's a social activity. If you're stopping just to save money you're in for a very hard time."

New Zealanders have slowly been stubbing out their habit during the past decade.

Matthew Allen says the number of smokers dropped by 2 per cent between 1990 and last year. Although it may not seem to be a big drop, each percentage point represents about 55,000 people, he says.

Statistics also show that those smokers who have not managed to give up, have certainly cut down.

Tobacco consumption has dropped by 30 per cent per adult for the same period.

"This is a big, big drop in consumption nationwide,"Mr Allen says.

Add to that the estimated seven per cent drop since May and more expected from this week's price rise, and the figure is likely to become a lot healthier.



Restrictions on tobacco advertising and bans on smoking in work and public places, have also played their part in reducing the smoke clouds, he says.

New health warnings on tobacco packaging and high media coverage of the impact of smoking have also contributed.

"It's a mix of things, with tax increase probably the most effective strategy for reducing smoking."

About $700 million a year is collected in excise tax. The bulk of it goes into the Government's consolidated fund.

High smoking rates among Maori remain a concern, prompting the $5 million earmarked in the last budget for Maori cessation services. These will run alongside the mainstream anti-smoking programmes.



Ministry figures show one in two Maori are cigarette smokers. For Pakeha, the figure is one in four, for Pacific Islanders one in three.

In 1996, Maori men's lung cancer death rates were three times higher than those of non-Maori men. Maori women's rates were four times higher than those of non-Maori women.

In 1996, tobacco smoking accounted for 17 per cent of all deaths. Among Maori, one third of all deaths between 1989 and 1993 were attributable to smoking.

But there are successes.

"A Maori womens pilot programme set up about a year and a half ago, attended by about 2000, recorded a quit rate at six months of 30 per cent which is an astounding result," Mr Allen says.

The American state of California, which has poured up to $100 million a year into media campaigns targeting the tobacco industry, recorded an 11 per cent fall in the number of smokers between 1985 and 1995.

Although tobacco is not taxed as highly in the United States as it is in New Zealand, price increases have had a large part to play in this success, Mr Allen says.

But for Catherine, tax hikes just have her reaching for the lighter.

"It's like everyone is trying to force me give up and that just makes me more determined to say "oh no, that won't work on me."

"Stupid, I suppose, but then so is smoking."