Talking About The Smokes MJA Transforming the evidence to guide Aboriginal 1 JUNE 2015 VOLUME 202 NO 10 and Torres Strait Islander tobacco control T H E M E D I C A L J O U R N A L O F A U S T R A L I A SUPPLEMENT Journal of the Australian Medical Association • Established in 1914 Print Post Approved PP255003/00505 Supplement 010615.indb 1 22/05/2015 7:44:21 AM Talking About The Smokes (TATS) is a model for how to do a large national epidemiological project in partnership with Aboriginal communities, the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Aboriginal community-controlled health service (ACCHS) sector. Research has not always been done well in or in partnership with Aboriginal and Torres Strait Islander communities, which can make undertaking research with the sector challenging. The TATS project, however, has always felt like a full and respectful partnership between the ACCHS sector and research organisations, and between Aboriginal and non- Aboriginal people. We have appreciated our involvement in all elements of the project, the clarity of the formal agreements, and the funding and support of project staff employed at NACCHO and in our member ACCHSs. Our concerns and priorities were always addressed. The ACCHS sector recognises how important undertaking research is to reduce smoking in our communities. Because TATS has been done ethically, we can have confi dence in using the evidence from this project to improve our policies and programs to reduce the damage that smoking does to our people and communities. Lisa Briggs Chief Executive Offi cer National Aboriginal Community Controlled Health Organisation Supplement 010615.indb 2 22/05/2015 7:45:42 AM Talking About The Smokes Transforming the evidence to guide Aboriginal and Torres Strait Islander tobacco control Project leader: David Thomas Better Knowledge, Better Health (Commissioned for Talking About The Smokes) Artist’s statement: I created this artwork to highlight the significance of the work that is currently being undertaken to tackle Indigenous smoking. Having worked in this area for almost 8 years, I have personally seen the changes our community is experiencing in the reduction of tobacco use. This artwork symbolises the unity between community and organisations (the circles) to reduce the burden of tobacco. Our people are becoming healthier and are living longer (symbolised by the leaves). The blue repeating pattern represents that we are forever learning, moving forward and improving our health by sharing the knowledge and information we gather through our stories and experiences. The white lines connecting the circles reflect the meaningful partnerships and connections we have to each other and to our communities. Jasmine Sarin February 2015 This supplement was supported by the Australian Government Department of Health MJA 202 (10) · 1 June 2015 S1 Supplement 010615.indb 1 22/05/2015 7:45:42 AM Contents S3 Talking About The Smokes: summary and S51 Personal attitudes towards smoking in a key findings national sample of Aboriginal and Torres David P Thomas, Maureen E Davey, Viki L Briggs, Strait Islander smokers and recent quitters Ron Borland Anna K Nicholson, Ron Borland, Pele T Bennet, Anke E van der Sterren, Matthew Stevens, S5 Research methods of Talking About David P Thomas The Smokes: an International Tobacco Control Policy Evaluation Project study S57 Social acceptability and desirability of with Aboriginal and Torres Strait Islander smoking in a national sample of Aboriginal Australians and Torres Strait Islander people David P Thomas, Viki L Briggs, Sophia Couzos, Anna K Nicholson, Ron Borland, Maureen E Davey, Jennifer M Hunt, Anke E van der Sterren, Pele T Bennet, Kathryn S Panaretto, Anke E van der Sterren, Matthew Stevens, David P Thomas Matthew Stevens, Anna K Nicholson, Ron Borland S63 Tobacco control policies and activities in S13 Talking About The Smokes: a large-scale, Aboriginal community-controlled health community-based participatory research services project Maureen E Davey, Jennifer M Hunt, Raylene Foster, Sophia Couzos, Anna K Nicholson, Jennifer M Hunt, Sophia Couzos, Anke E van der Sterren, Maureen E Davey, Josephine K May, Pele T Bennet, Jasmine Sarin, David P Thomas Darren W Westphal, David P Thomas S20 Past quit attempts in a national sample S67 Recall of anti-tobacco advertising and of Aboriginal and Torres Strait Islander information, warning labels and news smokers stories in a national sample of Aboriginal and Torres Strait Islander smokers Anna K Nicholson, Ron Borland, Maureen E Davey, Matthew Stevens, David P Thomas Anna K Nicholson, Ron Borland, Jasmine Sarin, Sharon Wallace, Anke E van der Sterren, S26 Predictors of wanting to quit in a national Matthew Stevens, David P Thomas sample of Aboriginal and Torres Strait Islander smokers S73 Smoking cessation advice and non- Anna K Nicholson, Ron Borland, Maureen E Davey, pharmacological support in a national Matthew Stevens, David P Thomas sample of Aboriginal and Torres Strait Islander smokers and ex-smokers S33 Smoke-free homes and workplaces of a David P Thomas, Pele T Bennet, Viki L Briggs, national sample of Aboriginal and Torres Sophia Couzos, Jennifer M Hunt, Kathryn S Panaretto, Strait Islander people Matthew Stevens, Ron Borland David P Thomas, Kathryn S Panaretto, Matthew Stevens, Pele T Bennet, Ron Borland S78 Use of nicotine replacement therapy and stop-smoking medicines in a national S39 Dependence in a national sample of sample of Aboriginal and Torres Strait Aboriginal and Torres Strait Islander daily Islander smokers and ex-smokers smokers David P Thomas, Viki L Briggs, Sophia Couzos, David P Thomas, Kathryn S Panaretto, Kathryn S Panaretto, Anke E van der Sterren, Matthew Stevens, Ron Borland Matthew Stevens, Ron Borland S45 Smoking-related knowledge and health S85 Smoking among a national sample of risk beliefs in a national sample of Aboriginal and Torres Strait Islander health Aboriginal and Torres Strait Islander service staff people David P Thomas, Maureen E Davey, Anna K Nicholson, Ron Borland, Sophia Couzos, Kathryn S Panaretto, Jennifer M Hunt, Matthew Stevens, David P Thomas Matthew Stevens, Anke E van der Sterren S2 MJA 202 (10) · 1 June 2015 Supplement 010615.indb 2 22/05/2015 7:45:46 AM Talking About The Smokes Talking About The Smokes: summary and key findings Transforming the evidence to guide Aboriginal and Torres Strait Islander tobacco control he baseline cross-sectional results from the Talking in a smoke-free home and have a history of recent quit About The Smokes project outlined in this supple- attempts. They can be confident that their messages will T ment (and summarised in the Box) provide the be understood and welcomed, then focus on the more most detailed national evidence yet to guide practice and difficult task of helping people to successfully sustain policy to reduce the harm caused by tobacco smoking their quit attempts. among Aboriginal and Torres Strait Islander peoples. The national prevalence of daily smoking in the Aboriginal Those working in clinics can build on their existing good and Torres Strait Islander population is falling, but at work in ensuring that most Aboriginal and Torres Strait 42% is still 2.6 times that of other Australians.1 Research Islander smokers regularly receive brief advice about evidence to guide Aboriginal and Torres Strait Islander smoking cessation. They can encourage more smokers to tobacco control has been constrained by the uncertain- use evidence-based measures to prevent relapse during their next quit attempt, such as stop-smoking medicines, David P Thomas ties of generalising from small local research projects MB BS, PhD, FAFPHM1 or from the large body of research in other populations. the telephone Quitline, and quit-smoking courses, clinics and groups. Maureen E Davey There have been competing hypotheses about whether 2 MB BS, FAFPHM Aboriginal and Torres Strait Islander smoking and quit- Those working in health promotion will need to con- Viki L Briggs ting behaviour is similar to or different from other popula- tinue to reinforce and enhance social norms about being BA, GDipIndigHlthProm, MPH3 tions. These new results suggest many similarities with smoke-free, to encourage quit attempts and to support Ron Borland other populations. smokers trying to sustain quit attempts. There is a need PhD4 We found the proportion of Aboriginal and Torres Strait for continued mainstream and national social marketing 1 Menzies School of Islander daily smokers who want to quit, have made a quit campaigns, especially those that build on the particular Health Research, Darwin, NT. attempt in the past year, live in smoke-free homes and salience of Aboriginal and Torres Strait Islander smokers’ 2 Aboriginal Health Service, work in smoke-free workplaces is similar to that of the concerns about the harmful effects of their smoking on Tasmanian Aboriginal general population. Similar proportions also demonstrate others. Local and Aboriginal and Torres Strait Islander Centre, Hobart, TAS. knowledge of the most harmful health effects of smoking campaigns also appear to be useful. 3 University of Melbourne, Melbourne, VIC. and hold negative personal attitudes towards smoking. There are also messages for public health professionals, 4 Cancer Council Victoria, Melbourne, VIC. But there are also differences. Fewer Aboriginal and Torres policymakers, funders and managers. They can justify david.thomas@ Strait Islander daily smokers than other Australians have investing health resources in tobacco control, not only menzies.edu.au ever made a quit attempt or sustained a quit attempt because smoking causes 20% of Aboriginal and Torres for at least a month, and a lower proportion agree that Strait Islander deaths,2 but also because improvement is social norms disapprove of smoking. Even though similar clearly possible. Our findings support maintaining an On behalf of the proportions agree that nicotine replacement therapy and ongoing commitment to a comprehensive approach to Talking About The Smokes project: stop-smoking medicines help smokers to quit, fewer have Aboriginal and Torres Strait Islander tobacco control, used these.