Samoan Smokers Talk About Smoking and Quitting: A Focus Group Study

Results of a community-based screening programme for chronic kidney disease and associated risk factors, (obesity, diabetes and hypertension) in a Samoan cohort

OBJECTIVES

In 2019, under the World Kidney Day theme of 'Kidney health for everyone everywhere', the National Kidney Foundation of Samoa undertook an extensive community screening campaign to detect the estimated prevalence of chronic kidney disease (CKD) and its associated risk factors in the community.

SETTING

Fifteen screening sites, with 11 urban and rural sites on the main island of Upolu, and 4 in different rural areas on the island of Savaii.

PARTICIPANTS

All participants were self-referrals to the various screening sites. In total, 1163 Samoans were screened, with similar numbers from both urban and rural areas and similar numbers of female and male.

SCREENING ACTIVITIES

All participants were screened for CKD using point of care serum creatinine determinations, with calculation of estimated glomerular filtration rate using the CKD-EPI formula and dipstix urinalysis. A standardised screening survey was used to capture demographic and medical history with associated risk factors of obesity, diabetes, using point of care determination of HbA1c and hypertension. Logistic regression was used to investigate the association of CKD with risk factors.

RESULTS

In total, 1163 people were screened for CKD within the month of March 2019. The prevalance of CKD (grades 1-5) was 44.5% (95% CI 41.6% to 47.4) with individual grade prevalence CKD 1: 3.7%, CKD 2: 6.1%, CKD 3: 30.7%, CKD 4: 2.9% and CKD 5: 1.0%. The prevalence of obesity (body mass index ≥32), diabetes and hypertension was 66.3%, 30.8% and 54.3%, respectively.

CONCLUSIONS

This is the first paper to report the estimated prevalence of CKD in Samoa or any other Pacific Island nation. It reveals an urgent need for further studies on the epidemiology of CKD in Samoa, to develop country-specific prevention strategies to mitigate this growing burden and prevent subsequent CKD associated complications including development of kidney failure and premature death.

Promoting Smoking Cessation in Costa Rica: A Focus Group Study of Smokers and Ex-Smokers

In developing worksite smoking cessation programs in Costa Rica, it is necessary to gain an understanding of smokers and ex-smokers. For smokers, it was necessary to know the barriers to quitting and what they thought may help them. For ex-smokers, we wanted to identify the main factors that helped them to successfully quit. Two separate focus groups were conducted of smokers ( n = 6) and ex-smokers ( n = 9) who worked at the Department of Justice. Results indicated that the key factors for both ex-smokers and smokers were social factors—family and coworkers. Participants viewed family support as fundamental to successful quitting. Smokers mentioned that the Justice Department could help them stop smoking by eliciting the support of ex-smoking coworkers. Major barriers to quitting were workplace stress and the presence of other smokers. In conclusion, family members and ex-smoking coworkers can play an important role in worksite smoking cessation programs in Costa Rica.

Tobacco smoking patterns in Samoa in 2010: Implications for interventions

INTRODUCTION

Tobacco use in Samoa has been described over time by age, sex and education, but little work exists on other sociodemographic factors associated with tobacco use. We describe current smoking and daily tobacco use in adults from Samoa, with a focus on sex and age stratified analyses of the influence of occupation, education, census region, household asset ownership and alcohol use in order to help develop potential targeted interventions.

METHODS

In 2010, a nationwide survey of 3745 adults aged 25–65 years from 33 villages was completed in Samoa. Current smoking status, daily tobacco use, as well as current alcohol use, and a variety of sociodemographic factors were assessed by interview. Bivariate and multivariable models, and sex and age group stratified analyses, were performed to determine different patterns of correlates.

RESULTS

More than half of all men (51.3%) and 21.8% of women were current tobacco smokers. Men and women smoked on average 10.9 and 8.7 cigarettes/day, respectively. Twenty per cent of men consumed ≥20 cigarettes/day. In men, being married, a subsistence-farmer/laborer, an alcohol user, and having low household assets, were independently associated with being a tobacco smoker (all p<0.01). Among women, not completing secondary education, being 25–34 years, residing in urban Apia, and being an alcohol user, were independently associated with being a tobacco smoker (all p<0.01).

CONCLUSIONS

Tobacco use in Samoa remains high and correlates of smoking suggest that interventions for cessation need to be developed within the contexts of sex, age, education, and household socioeconomic status.

Psychosocial characteristics of smoking patterns among young adult Samoans and Tongans in California

INTRODUCTION

Despite the high burden of tobacco-related diseases experienced by Samoans and Tongans, there is relatively little understanding of the factors that influence their smoking behaviors which could inform effective smoking cessation strategies. This study examined several psychosocial characteristics that intertwine to predict smoking patterns in these Pacific Islander subgroups.

METHODS

Samoans and Tongans between the ages of 18 and 33, who consumed at least 100 cigarettes in their lifetime and were current smokers, were categorized as light, moderate, or heavy smokers. Baseline data from a randomized controlled smoking cessation trial were analyzed. Participants (n = 278) were measured on self-efficacy, perceived stress, sensation seeking, hostility, depression, and impulsivity. Least square means estimated from General Linear Models were used to compare psychosocial characteristics across smoking groups, as well as by gender and ethnicity.

RESULTS

Samoan male heavy smokers reported higher levels of self-efficacy compared to light smokers, and greater stress, hostility, depression, and urgency over moderate smokers. Samoan female heavy smokers demonstrated greater stress and hostility than moderate and light smokers. Tongan female heavy and light smokers had significantly elevated levels of sensation seeking compared to moderate smokers. Tongan male smokers did not display any meaningful associations with these psychosocial constructs.

CONCLUSIONS

This study underscores the important distinctions between smoking patterns, gender, and ethnic subgroups. Interventions that rely on aggregated smoking profiles or general Pacific Islander data may not adequately address the complex array of mental health factors that contribute to tobacco use.

Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study

Background

Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable.

Objective

This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use.

Methods

Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context.

Results

The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages.

Conclusions

Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country.