Rowena Ivers

Where there's smoke, there's fire: high prevalence of smoking among some sub-populations and recommendations for intervention

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.

A review of tobacco interventions for Indigenous Australians

Objective:To conduct a review of interventions to reduce the harm resulting from tobacco use among Indigenous Australians and to discuss the likely effect of a range of tobacco interventions if conducted in this population.

Aboriginal and Torres Strait Islander Australians and tobacco

Suffering high mortality and morbidity rates from conditions related to tobacco use Australia is considered to be a leader among developed nations in the area of tobacco control. Well coordinated and sustained tobacco control programmes are likely to have resulted in long term health gains, including a decrease in mortality rates from cardiovascular disease, and subsequent increases in life expectancy. However, Aboriginal and Torres Strait Islander people—the indigenous people of Australia—continue to suffer high mortality and morbidity rates from conditions related to tobacco use. Indeed, tobacco is the main cause of preventable mortality among Aboriginal and Torres Strait Islander Australians.1 How is it that a minority group within a wealthy nation can display such marked health status and tobacco use differences from others in that population? What has been done to attempt to redress this disparity? What are the needs and priorities for the future? In this commentary, we describe cultural, historical, and political factors leading to the high prevalence of smoking among Aboriginal and Torres Strait Islander people. We outline and discuss intervention efforts undertaken so far and consider their merits and weaknesses, paying particular attention to resource allocation issues. Finally, we consider priorities for future programme delivery that would be most likely to result in reduced tobacco use among this population. As for other indigenous people worldwide, particularly those who have been colonised by other people (for example New Zealand Maori,2 native Canadians,3 and native Americans), the prevalence of tobacco use is higher among Australian Aboriginal and Torres Strait Islander people than for other Australians. In the National Aboriginal and Torres Strait Islander Survey4 conducted in 1994, 54% of Aboriginal and Torres Strait Islander men and 46% of Aboriginal and Torres Strait Islander women were smokers, with very few Aboriginal and Torres Strait Islander …

An evidence-based approach to planning tobacco interventions for Aboriginal people

Systematic reviews have shown that interventions such as the delivery of cessation advice by heath professionals and the use of nicotine replacement therapy are effective at increasing cessation rates, however little is known about whether such interventions are appropriate and effective for and thus transferable to Aboriginal Australians. The aim of this paper was to assess whether evidence of effectiveness for brief interventions for cessation and nicotine patches from studies conducted in other populations was likely to be transferable to Aboriginal people in the NT. This paper involved assessment of systematic reviews of evidence for the use of brief interventions for smoking cessation and the use of nicotine replacement therapy, when planning two such interventions for delivery to Aboriginal people. Emerging themes are discussed. There were many factors which were likely to mean that these brief advice on cessation and the use of nicotine patches were likely to be less effective when implemented in Aboriginal communities. The planned interventions were delivered in primary care, and were of low intensity. Few studies included in systematic reviews were set in the developing world or in minority populations. Many features of the context for delivery, such as the normality of the use of tobacco among Aboriginal people, the low socio-economic status of this population and cultural issues, may have meant that these interventions were likely to be less effective when delivered in this setting. Further research is required to assess effectiveness of tobacco interventions in this population, as evidence from systematic reviews in other populations may not be directly transferable to Aboriginal people.

A study of the use of free nicotine patches by indigenous people

Objective: To assess use of free nicotine patches by Indigenous people when offered a brief intervention for smoking cessation, and to assess changes in smoking behaviour at six months.

Using breath carbon monoxide to validate self-reported tobacco smoking in remote Australian Indigenous communities

BackgroundThis paper examines the specificity and sensitivity of a breath carbon monoxide (BCO) test and optimum BCO cutoff level for validating self-reported tobacco smoking in Indigenous Australians in Arnhem Land, Northern Territory (NT).MethodsIn a sample of 400 people (≥16 years) interviewed about tobacco use in three communities, both self-reported smoking and BCO data were recorded for 309 study participants. Of these, 249 reported smoking tobacco within the preceding 24 hours, and 60 reported they had never smoked or had not smoked tobacco for ≥6 months. The sample was opportunistically recruited using quotas to reflect age and gender balances in the communities where the combined Indigenous populations comprised 1,104 males and 1,215 females (≥16 years). Local Indigenous research workers assisted researchers in interviewing participants and facilitating BCO tests using a portable hand-held analyzer.ResultsA BCO cutoff of ≥7 parts per million (ppm) provided good agreement between self-report and BCO (96.0% sensitivity, 93.3% specificity). An alternative cutoff of ≥5 ppm increased sensitivity from 96.0% to 99.6% with no change in specificity (93.3%). With data for two self-reported nonsmokers who also reported that they smoked cannabis removed from the analysis, specificity increased to 96.6%.ConclusionIn these disadvantaged Indigenous populations, where data describing smoking are few, testing for BCO provides a practical, noninvasive, and immediate method to validate self-reported smoking. In further studies of tobacco smoking in these populations, cannabis use should be considered where self-reported nonsmokers show high BCO.

Evaluation of a multi‐component community tobacco intervention in three remote Australian Aboriginal communities

Objectives: To assess the effect of community tobacco interventions in Aboriginal communities.

An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland

Objective: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland.

Smoking, nutrition, alcohol and physical activity interventions targeting Indigenous Australians: rigorous evaluations and new directions needed

Objective: To describe and critique methodological aspects of interventions targeting reductions in smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) among Indigenous Australians.

Cannabis: a Trojan horse for nicotine?

[Extract] The recent report published by the AMA and APMA into Indigenous tobacco issues raised important questions regarding the implementation of effective strategies to reduce high levels of tobacco smoking and related harm in this population. We are currently working on separate projects within the Top End of the Northern Territory to support smoking cessation in the Aboriginal population and also to develop interventions to reduce harm associated with excessive cannabis use by Aboriginal youth.