Jacqueline A. Bowden

People with mental illness can tackle tobacco

Objective: To evaluate a smoking reduction and cessation intervention tailored for people with significant disability associated with mental illness. Method: The intervention was a 10 week group programme, which tailored smoking cessation interventions to the needs of people living with mental illness. It was facilitated by mental health workers and peer workers and was promoted through mental health services, general practitioners and the Quitline phone service. Participants were people living with mental illness who had asked for help to quit or reduce their tobacco use. Participants were interviewed before starting the course, twice during the course and at 3, 6 and 12 months post course completion. Results: Overall, 226 people expressed interest, 183 attended at least one session of the course and 105 attended at least 10 sessions. Of the 183 participants, 79.8% reported they did not smoke for at least 24 hours, with 30.6% stopping for at least 30 days. At the 12 month follow up 16.6% of participants reported they were not smoking. Of the 105 participants who attended at least 10 sessions of the course, 85.7% reported they did not smoke for at least 24 hours and 37.1% stopping for at least 30 days. At 12 month follow up 21.3% reported they were not smoking. Cigarettes smoked per day declined among those who did not quit, and was still significantly lower after 12 months. Motivation to try to quit was high among those still smoking at 12 months, with 83.9% wanting to try again to quit. Conclusions: This programme has shown many people with significant disability associated with mental illness are motivated to attend a smoking reduction and cessation group programme. A programme tailored to meet the specific needs of this group can be effective in helping many to quit or reduce their tobacco use.

Predictors of chronic breathlessness: a large population study

BackgroundBreathlessness causes significant burden in our community but the underlying socio-demographic and lifestyle factors that may influence it are not well quantified. This study aims to define these predictors of chronic breathlessness at a population level.MethodsData were collected from adult South Australians in 2007 and 2008 (n = 5331) as part of a face-to-face, cross-sectional, whole-of-population, multi-stage, systematic area sampling population health survey. The main outcome variable was breathlessness in logistic regression models. Lifestyle factors examined included smoking history, smoke-free housing, level of physical activity and body mass index (obesity).ResultsThe participation rate was 64.1%, and 11.1% of individuals (15.0% if aged ≥50 years) chronically had breathlessness that limited exertion. Significant bivariate associations with chronic breathlessness for the whole population and only those ≥50 included: increasing age; female gender; being separated/divorced/widowed; social disadvantage; smoking status; those without a smoke-free home; low levels of physical activity; and obesity. In multi-variate analyses adjusted for age, marital status (p < 0.001), physical activity (p < 0.001), obesity (p < 0.001), gender (p < 0.05) and social disadvantage (p < 0.05) remained significant factors. Smoking history was not a significant contributor to the model.ConclusionsThere is potential benefit in addressing reversible lifestyle causes of breathlessness including high body mass index (obesity) and low levels of physical activity in order to decrease the prevalence of chronic breathlessness. Clinical intervention studies for chronic breathlessness should consider stratification by body mass index.

Alcohol consumption and NHMRC guidelines: has the message got out, are people conforming and are they aware that alcohol causes cancer?

Objective: To examine self‐reported alcohol consumption and relationships between consumption, awareness of the 2009 NHMRC guidelines of no more than two standard drinks per day, drinking in excess of the guideline threshold and perceptions of alcohol as a risk factor for cancer.

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

To What Causes Do People Attribute Their Chronic Breathlessness? A Population Survey

OBJECTIVE Chronic breathlessness is a daily experience for millions of people, despite current therapies. The objective of this study was to find out to what people attributed their breathlessness irrespective of health service utilization, and to understand the demographic characteristics in each diagnostic group. METHODS A face-to-face, population-based survey (n=4432) asked community-dwelling South Australians the modified Medical Research Council (breathlessness) Scale (mMRC), and, if they were breathless was it chronic (daily for at least 3 of the last 6 months), total duration of this breathlessness and to what body system they attributed their breathlessness. Categorical and continuous variables were analyzed appropriately. RESULTS With a participation rate of 63.7%, 8.9% of respondents had an mMRC score ≥1. Breathless people were older (54.3 years SD 19.5, versus 44.9 years SD 18.7; p<0.001), most often attributed their chronic breathlessness to lung disease (65%) and, if breathlessness was the result of lung disease, experienced chronic breathlessness for significantly longer periods of time (13.8 years, SD 15.8) compared with other attributed causes (5.7 years; SD 9.1; p<0.001). CONCLUSION Breathlessness is widely encountered. The burden in prevalence and duration generated by lung disease greatly surpasses other causes. This underlines the need to intensify efforts to minimize the causes of chronic lung disease, and to more actively palliate the subjective symptom of chronic breathlessness.

Smoking and mental illness: a population study in South Australia

Objective: To examine smoking prevalence and smoking behaviour among South Australians with a mental illness and compare findings to those with no mental illness. Method: Data were collected in three cross-sectional representative population surveys of South Australians aged ≥15 years from 2005 to 2007. Merged data yielded a total sample size of 8417. The main outcome measures were: smoking prevalence, measures of tobacco dependence, awareness of the health effects of active and passive smoking, smoke-free homes and cars, awareness of health warnings, and use of cessation aids by two measures of mental illness status. Results: Overall 26.4% of the population with a general mental illness and 51.2% of the population with a severe mental illness smoked, compared to 18.7% of the population without a mental illness. People with a mental illness, particularly severe mental illness displayed higher measures of tobacco dependence. Smokers with a severe mental illness were less likely to have smoke-free homes (OR = 0.29, 95%CI 0.16-0.55). Television was an effective medium to present the health effects of smoking to all groups. Those with a general mental illness were more likely than those with no mental illness to have asked a general practitioner for advice to help them quit in the past year (OR = 2.02, 95%CI 1.07-3.84). Conclusions: Whilst smokers with a mental illness are more dependent on their smoking; they are interested in quitting. There are a number of mainstream tobacco control strategies that could be further utilized (e.g. mass media and health professional referrals to the Quitline) to increase cessation among this disadvantaged group.

An integrated brief intervention to address smoking in pregnancy

Objective. Evaluate the impact of an integrated brief intervention to assist antenatal staff in addressing smoking with pregnant women. Design. Three studies were conducted: (a) antenatal staff surveys pre‐ and post‐training to deliver the brief intervention; (b) retrospective audit of pregnancy records; (c) post‐intervention follow‐up interviews with a cohort of pregnant women who smoked at baseline. Setting. South Australia. Sample. (a) Antenatal health professionals at two major birthing hospitals (n = 117 pre‐survey and n = 62 post‐survey); (b) 1,024 pregnancy records; (c) follow‐up interviews with women at one month (n = 58), 6 months (n = 40) and 12 months (n = 31) post‐intervention. Methods. (a) Staff surveys about current practice prior to training (via written questionnaire) and 12 months post‐training (by telephone); (b) pregnancy record audit for presence and use of the Smoke‐Free Assessment & Intervention Form (SFA&IF) conducted at 12 months; (c) telephone surveys assessing smoking behavior. Main Outcome Measures. Staff practice change and compliance with the intervention. Cessation rates among pregnant women. Results. At 12 months, 89% of staff reported that the intervention integrated well into their work; The SFA&IF was physically present in 80% of pregnancy records and 89% had been completed. Over 65% of current smokers were offered advice about the benefits of quitting; quit rates were highest at 6 months (18, 13% conservative estimate), but women tended to relapse after the birth of their baby. Conclusions. The intervention was well‐received and staff compliance was high. Quit rates exceeded spontaneous quit rates in the community. This project has been expanded nationally.

What happens when the price of a tobacco retailer licence increases

Objective To measure the impact of a 15-fold licence fee increase on tobacco retailer licence renewals. Methods The regulatory change increasing tobacco licence fees (from

Tobacco use among urban Aboriginal Australian young people: a qualitative study of reasons for smoking, barriers to cessation and motivators for smoking cessation

A12.90 to

Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia

A200 per annum) took effect on 1 January 2007. Government Tobacco Licence records (n=7093) were audited for 1 year prior to, and 2 years after the change. An interrupted time series analysis using ARIMA modelling was conducted to examine the impact of fee increases on the number of active licences. Results The total number of tobacco licences decreased by 23.7% from December 2007 to December 2009. The increased tobacco licence fee implemented on 1 January 2007, was associated with a significant reduction in the number of tobacco licences purchased or renewed in subsequent years. Of the 1144 entertainment licensees holding valid licences in December 2007, 30.9% no longer held a licence by December 2009, and 19.9% had reduced the number of points of sale within the same venue. Conclusions Licensing of tobacco retailers has received little attention in tobacco control in Australia and internationally. Our data add to the growing body of evidence supporting further regulation of retail sale of tobacco. The results demonstrate that a tobacco licence price increase off a low base is a potentially effective method of reducing tobacco points of sale when consumer demand for cigarette products is low. However, further research is needed to identify additional measures that may be necessary to reduce the availability of tobacco products in areas where consumer demand for cigarettes is high.