Cytisine's potential to be used as a traditional healing method to help Indigenous people stop smoking: A qualitative study with māori

Introduction: Māori experience a disproportionate amount of smoking-related harm (46% of adult Māori smoke). Effective cessation treatments that are both accessible and attractive to Māori are urgently needed. Cytisine (a plant extract found in Golden Rain [Cytisus laburnum L.] and the New Zealand Kowhai [Sophora tetraptera L.] has a similar molecular makeup to nicotine, has been used successfully as a cessation product in central and eastern Europe and central Asia for many years, and is low priced. Recent reviews have found that cytisine is twice as effective as a placebo for smoking cessation. This study aimed to explore cytisine's potential as a 'rongoā Māori' (traditional Māori remedy) and its attractiveness to Māori smokers compared with other cessation products. Methods: Māori that smoked were interviewed in two focus groups and eight individual semi-structured interviews. Two key informants were interviewed also. Results: Barriers to using cessation products were financial and effort cost, pervasive smoking among family and peers, environments permissive of smoking, and perceived cultural inappropriateness of treatments. Participants were very interested in cytisine, supported the idea that it would be acceptable to package it as a rongoā Māori, and all wanted to use it. Named appropriately, packaged and promoted as a Māori cessation product, participants thought cytisine would contribute to the restoration of Māori identity and traditional beliefs and practices in addition to reducing smoking. Conclusions: Presented as a rongoā Māori, cytisine would likely be more attractive to Māori than currently available cessation products. Confirmation of efficacy and safety will be needed before promotion of the product could occur.