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

Introduction: Samoa, like other Pacific Island countries, faces a persistent challenge to reduce smoking use with relatively limited resources. As a signatory to the WHO FCTC, Samoa is obligated to introduce measures to reduce tobacco use and is currently trialing a text message smoking cessation programme (mCessation) to achieve this outcome. Cigarettes remain relatively cheap and are widely available, but little is known about how smoking is initiated or why and how people quit smoking in the Samoa.

Methods: Six focus groups with smokers and ex-smokers were conducted in Apia, Samoa. Groups were homogenous according to age, gender and smoking status. Focus groups were conducted in Samoan and transcribed and translated to English for analysis.

Results: Smoking is initiated most commonly in late teens and early twenties and most frequently in (non-family) social contexts. Smoking reflects a widely held (mis)perceptions of tangible benefits, including aiding feelings of strength and energy, relief from indigestion and as a means to accelerate the effects of alcohol. Smoking was deeply connected to social life in Samoa among friends and for some, with family members. Drivers to quit originate out of concern regarding health effects, concern for family and the costs of purchasing tobacco.

Conclusions: Smoking is well entrenched in Samoan society; efforts to reduce smoking need to be based on implicit understanding of Samoan cultural norms and priorities around family, social networks and culture. Efforts to support quitting are important, alongside other well validated measures to reverse the trajectory of smoking related disease.

Implications: This study offers an insight into smoking as a behavior and as cultural practice perceived by smokers and non-smokers in Samoa. A thorough understanding of smoking behaviors and cessation patterns is critical in efforts to reduce smoking especially in resource-limited settings. The results from this study was used to inform the development of a Samoan mHealth smoking cessation programme.