In the 2006 census, approximately 8% of New Zealand smokers were of Pacific ethnicity (over 50,000 including youth).1 Pacific children are more likely to be exposed to secondhand smoke than non-Pacific children. While the reported smoking in the homes of Pacific Year 10 students declined from 35% to 22% during 2001-2008, this compares to an equivalent figure of 17% in 2008 for European/Other students.2 Tobacco use contributes significantly to the health inequalities between Pacific and other New Zealanders.3,4 In particular, Pacific children have higher rates of hospitalisation for acute and chronic respiratory diseases than any other ethnic group in New Zealand.5There is strong support by Pacific peoples for greater government intervention on smoking around children. In a 2008 New Zealand survey of 324 Pacific adults, 92% agreed that smoking should be not be allowed in cars with children under the age of 14, and 73% agreed that smoking should be banned in all outdoor public places where children are likely to go.6 In a 2007-8 survey of 90 Pacific smokers, 85 (95%) disagreed with the statement: Smoking should be allowed in cars with pre-school children in them.7There have been a number of recommendations by Pacific researchers and non-government organisations, and from fono(meetings), on policies needed to improve tobacco-free and smokefree activity for Pacific peoples in New Zealand. These have included the need for more staff of Pacific ethnicity employed specifically for smokefree work, and a greater focus on smokefree material in Pacific languages.8 Current knowledge about effective smokefree policies suggest the need for increasing smokefree home, car, school, work, and play environments, both inside and outside,9 through comprehensive tobacco control programmes that include mass media campaigns and smokefree places legislation.10To date, there has been little published research on possible Pacific solutions to reducing smoking around Pacific children, and none on the attitudes of Pacific policymakers on this issue (that is, politicians and senior officials). This article begins the exploration of these attitudes.Methods A range of documentary and media sources were searched for relevant Pacific policymaker attitudes. The Factiva media database was searched for the New Zealand region. The websites of the following organisations were searched: New Zealand Government (http://www.beehive.govt.nz/ and http://www.executive.govt.nz/96-99/index.html) Ministry of Pacific Island Affairs and Pacific Islands Heartbeat. Further sources were suggested by the material found, and by interviewees. A semi-structured interview schedule was developed. The schedule included questions on the interviewees views on what needs to take place to reduce smoking around Pacific children, and examples of effective decision-making processes for reducing smoking around Pacific children. As context to the views on solutions to reducing smoking around Pacific children, we asked questions about the relative importance of secondhand smoke harm to children, and the significance of the example of smoking to them. A purposeful sample of key informants was identified, using Pacific tobacco control and health networks, and by examining the Pacific membership of health decision making structures in New Zealand. The criteria for selection included Pacific ethnicity, closeness to, or a clear view of, health policy decision-making. The sample was augmented by snowballingasking those interviewed who they thought should be included in the research. An information sheet, consent form and proposed questions were provided by email prior to the interview. Interviews (on the basis of anonymity) were conducted by Pacific interviewers during May-October 2008, in person or by phone, and were taped and transcribed. Ethics approval for the process was obtained through the University of Otago ethics review process. The documentary and interview data were analysed for themes by the first two authors. Some of the themes emerged from the questions asked. Themes identified in a preliminary analysis were adapted and changed, as further themes emerged through discussions. Results Seventeen interviews with 18 interviewees were conducted (one interview was of two people together). The 18 interviewees included two current or ex-MPs, five senior officials from District Health Boards (DHBs), seven senior central government officials with expertise in health policymaking, and four senior officials from non-government organisations (two had been government officials) with knowledge of, and interest in, Pacific tobacco control. They all had a minimum of 10 years experience within health policy. While the interviews gave a wide range of ideas and views, the decreasing incidence of new views and ideas by the end of the series indicated that the number of interviewees was sufficient for an exploratory study (some saturation of themes was occurring). Little relevant comment by Pacific policymakers was found in the documentary sources. As context, it was clear that there was high concern by the interviewees about the exposure of children to secondhand smoke, and that role modelling by smokers was seen as a major threat to Pacific children. How to reduce smoking around children The ideas of Pacific policymakers are given below in two main sections. First, general ideas, and second, those that particularly relate to homes, cars, playgrounds and church grounds. General ideasThe general ideas covered the education and persuasion of adults (particularly parents), ethnic-specific programmes, and the use of avenues that may be particularly effective for Pacific peoples (e.g. churches, the use of Pacific role models). Changing attitudes and knowledgeThere was a strong theme of the need to change the knowledge and attitudes of Pacific adults, particularly smokers and parents: Weve got to educate people who are making the smoking environment around those children. Its the home, the car, the church, outside the church, those kinds of environments that weve got to change. And it will be the adults that are responsible for those environments that have got to see the need for a change. (Interview 15) The home and parents were a major focus of comments: Inform and educate parents about the dangers of [adult] smoking for their children, and encourage them to perhaps not smoke in the house or in the car. (Interview 12) Everything must start from the home, and the family unit is the fundamental unit of any community and society. The roles of parents become critical in ensuring that kids are protected from [tobacco smoke]. (Interview 16) This theme was echoed in 2008 by the then Minister of Pacific Island Affairs, Hon Winnie Laban, when speaking of all health initiatives for Pacific children: [The] inclusion of families. ...this is an important theme for any response that we develop for our childrenit is crucial that we encourage and support Pacific families to make positive steps to benefit their children.11 Some mentioned the role of grandparents in childcare, and their influence on grand children: Grandparents play a very big part in the lives of the grandchildren. And often the grandparents are the ones to get to about making the rules. ... theyve got to be factored in somehow. (Interview 12) Other comments were on the need for language specific education programmes for older people: I think there is still space for language-specific targeting of educational programmes. (Interview 6) Interviewees also saw a need to allow for the wider influences on Pacific youth: ...the kids/youth nowadays, they are more connected to BEBO [a social networking website] than they are to Tonga or to where they come from. So I think we have to think of things a little bit differently. (Interview 4) ChurchesAll interviewees acknowledged the important place of the church in Pacific families and communities. Working and building relationships with churches was seen as crucial: In the Pacific community, the church is a significant part of their upbringing, and so what the church is going to agree to is going to have a huge influence over their behaviour. (Interview 15) Churches probably need to do a little bit more ... The churches are the villages, so a lot of information can go out there. Not all of them are prepared to participate, but by and large, most churches will give the opportunity for these kinds of message to be promoted to the young people. Some churches do it really, really well. (Interview 16) Another repeated theme was the need for a spiritual aspect to smokefree efforts: You go to church for your spiritual growth, and smoking does not contribute any spiritual growth in relation to Christianity or to other beliefs as well. It should be seen as an evil substance and I think that is what they should preach in the churches, to make it non-acceptable for smoking. (Interview 1) Message contentThe interviewees emphasised that the need to protect children was an effective way of communicating with Pacific audiences: ...youre doing harm to your kids, I think that that has a high likelihood of appealing, or having some impact to the parents, and adults and caregivers. (Interview 12) Part of the message needed was that Pacific children have: ...the highest rates of admissions to hospital for respiratory illness. (Interview 17) One interviewee recommended promoting the positive side of not smoking rather than the negative messages about smoking: Positive things ... this is what you can be if you dont smoke or if you eliminate smoking, this is what you can achieve. (Interview 5) Another interviewee thought that the use of shocking images and messages is needed to shake Pacific peoples into action: Shock tactics that kind of shake our people to think or see what the consequences are ... but it has to be language-specific [to provide] for our older folks. (Interview 6) Structural ideasThere was a strong theme of a need for Pacific-specific policies. The major documented comment we found on a necessary direction for government policy was by the Chief Executive of the Ministry of Pacific Affairs, in 2007: Continued reliance and adaptation of mainstream tobacco control interventions is unlikely to reduce tobacco use among Pacific peoples in Aotearoa/New Zealand. More specific programmes for Pacific peoples are urgently needed, with particular focus on young men. Effective interventions to reduce tobacco-related deaths will substantially reduce health inequalities in the country. Pacific communities need to be resourced and supported to own and participate more effectively in the provision of tobacco control programmes.12 The Pan-Pacific approach to tobacco control was seen by interviewees to have worked to some extent, but in order to move forward, they recommended an ethnic group specific approach. This was due to the ethnic differences in the smoking prevalence statistics of Pacific peoples: Rather than taking a blanket approach, we do know there are ethnic differences ... we should certainly be looking at those differences, and then targeting the policies more at those sort of differences. (Interview 12) Some of the structural solutions suggested by policymakers included a more ethnicity targeted approach for policies: ...if you think about the standard New Zealand smoke policy, we try and put everyone in it, and it probably applies to Palangi [Pakeha/European New Zealanders]. But the characteristics in Pacific communities are so different, and isnt going to be effective for them. Thats why I think a more targeted approach to policy, addressing and focussing on those most at risk, is a far better approach. (Interview 12) Another theme was of the need for resources for Pacific tobacco control: If you look at the smoking rates in New Zealand, and the amount of resource that goes into it, ... its inadequate. (Interview 12) And to get resources to providers and community groups: ...because theyre the ones that are going to have to fight it, and [should] be given the resources. (Interview 1) This included a bottom-up approach for interventions, with communities developing their own priorities, rather than a top-down approach: You go out to the community, and you ask them what they think. And that is why some of the things are working, because they have developed the priorities for their community and they [the community] drive it. (Interview 2) Another interviewee felt that the only way to stop people from smoking around children is to ban tobacco altogether: Regardless of how much they keep putting up the price of cigarettes, people will still buy them because they are there, but if they take it away, ban tobacco, then no one will buy it. (Interview 14) Many interviewees suggested restricting some of the environments where people could smoke: Restrict the different environments they [can smoke] in ... for the good of the public. And I think it would also give them a strong message that hey, we dont like smoking...We should ban smoking from anywhere near where children are, whether its indoor or outdoor. (Interview 4) And being consistent in being smokefree in any health-related setting: Youre going to push for like a healthy event; you should always have smokefree as your message. (Interview 9) Ideas about policies for homes, cars, playgrounds and church groundsA number of interviewees had strong views on smokefree homes, cars, playgrounds and church grounds: Ban smoking in homes, cars, playgrounds and church grounds. (Interview 3) People should not smoke in their homes at all. Children are often in cars and they breathe in all the poisons. (Interview 1) I just wish it was [required] for people not to smoke in vehicles, with passengers in there. (Interview 9) However, some interviewees felt that homes and cars are private, and gave varied ideas about ways to reduce smoking in these areas, such as community persuasion or norm setting: Its peoples private homes but still, if they are going to smoke, not inside but away from where children are, not in the garage. Probably somewhere in the back yard or under the tree or even around the corner somewhere, down the road. (Interview 1) Some were particularly reluctant to impose on private choices: I would like to think that they shouldnt smoke in any of those areas but their car is their own property, their house is their own property. (Interview 4) Its a balance between the rights of the families to freedom and personal choice, but also the welfare of children. (Interview 11) So its about people being able to make decisions for themselves, and hopefully they will make it based on good evidence, and good information about the dangers of smoking ... people can and should make these decisions for themselves. (Interview 7) Regulatory measures in that direction might be going a bit too far. So I dont believe that regulatory approaches in those sorts of environment are going to be feasible, but I certainly think an educational approach might work. Thats in the private sort of environment, like homes and cars. (Interview 12) Therefore, in order to try and change behaviour in hard-to-regulate places, one interviewee suggested changing the social acceptability in a setting as an alternative approach: Change the social acceptability in a setting, and raising the awareness of it, of all the different environments which you wouldnt expect [smoking]. (Interview 8) Another interviewee suggested starting with the smoke outside campaign rather than banning smoking around private properties: I think well take the smoke outside sort of campaign, and highlight [how] other people are affected by ... smoke. (Interview 4) Church groundsThere were mixed attitudes about smoking in church grounds. Some interviewees were aware that some churches already banned smoking in their church grounds: Church grounds, Im not sure that we have explored what the policy is. ... theyre kind of privately-owned property, like homes and cars.... (Interview 8) They shouldnt be smoking [there]. Its the same reason why I think they shouldnt be drinking beer at church functions. (Interview 4) [Smoking in church grounds and playgrounds] that should be regulated, in a useful and effective way. (Interview 11) Playgrounds and parksSome suggested that playgrounds and parks should be smokefree because it is a natural environment for families to spend quality time together: Parks are supposed to be a natural place for people to go and then you got people smoking. Thats not natural...and thats interfering with nature...Playgrounds are place where families enjoy being in the outdoors and having family time. If you got people smoking it just ruins that time. It also impacts on [those] who are around breathing in the smoke. (Interview 1) A park is where you go and get fit....children run around...and having smoking as part of that is an undesirable association. (Interview 13) However, some felt that smoking in playgrounds was alright, as long as smokers are away from the children: Play grounds [and] wide open spaces, so long as they dont smoke over the kids .... Sometimes we encroach on peoples rights; its their choices. (Interview 5) Other outdoor places that should be smokefreeWhen asked about other outdoor places that should be smokefree, two interviewees suggested promoting smokefree outside events, such as the ASB Polyfest annual outdoor cultural festival in Auckland, for example: The ASB Polyfest. We are trying to make it completely smokefree. Its not completely smokefree yet but we have seen the huge difference from last year to this year. A lot more people not smoking and going outside these sites rather than smoking inside. We still got a long way to go but I think we did make a huge impact in the ASB Polyfest environment to make it smokefree. (Interview 1) We should have smokefree events. ... outside events, there shouldnt be any smokers around. (Interview 16) A few interviewees felt that any public places where people congregate should be smokefree, particularly those areas where there are young children (and several particularly mentioned swimming pools): Every place where people congregate. And where ... young children are, [smoking] should be barred, should not be allowed....Whether its the church, or car parks, or whatever. (Interview 18) Pools, hot pools, beaches... they shouldnt allow people to smoke there. I just dont think we can afford to associate cigarette smoking with anything pleasant or nice. (Interview 13) Auckland Airport are really good because they have smokefree areas and smoking areas [outside]. (Interview 1)