Tobacco control in a traditional Fijian village: Indigenous methods of smoking cessation and relapse prevention

This case study outlines the unique process by which a village in Fiji (N = 238) developed and implemented an extremely successful community-based smoking cessation program. Both Western smoking cessation methods and native traditional rituals were used. Specific strategies included a group pledge, village rapid inhalation ceremony, social contracting through notices and media, and a tabu formalized through a kava ceremony. Whereas the more conventional, external, health professional oriented approaches were largely unsuccessful, longer term collaborative and village empowerment methods proved most successful. Eventually all persons in the village who smoked were able to give up smoking, with specific exceptions (elders, visitors, etc.) and became nationally known as the village that gave up smoking. Follow up evaluation at 9 and 21 months indicated sustained success. Cases of relapse are described involving supernatural consequences remedied by group and ceremonial methods. The socio-cultural context and larger relationship issues are discussed in order to more fully understand the effectiveness of the program.