Objectives: To examine indicators of nicotine dependence in a national sample of Aboriginal and Torres Strait Islander daily smokers and their association with sustaining a quit attempt for at least 1 month, and to make comparisons with a national sample of Australian daily smokers.
Design, setting and participants: The Talking About The Smokes project used a quota sampling design to recruit 1392 daily smokers from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait from April 2012 to October 2013. These were compared with 1010 daily smokers from the general Australian population surveyed by the International Tobacco Control Policy Evaluation Project from September 2011 to February 2012.
Main outcome measures: Cigarettes per day (CPD), time to first cigarette, Heaviness of Smoking Index (HSI), other indicators of dependence, and whether smokers had ever sustained a quit attempt for at least 1 month.
Results: There was little difference in the mean HSI scores for Aboriginal and Torres Strait Islander and other Australian daily smokers. A higher proportion of Aboriginal and Torres Strait Islander daily smokers smoked ≤ 10 CPD (40% v 33.4%), but more also smoked their first cigarette within 30 minutes of waking (75% v 64.6%). Lower proportions of Aboriginal and Torres Strait Islander smokers reported having strong urges to smoke at least several times a day (51% v 60.7%) or that it would be very hard to quit (39% v 47.9%). Most Aboriginal and Torres Strait Islander smokers reported experiencing difficulties during their most recent quit attempt. All indicators of dependence, except CPD and strong urges, were positively associated with not having made a sustained quit attempt. Reported difficulties during the most recent quit attempt were more strongly associated with being unable to sustain quit attempts than were traditional measures of dependence.
Conclusion: Aboriginal and Torres Strait Islander smokers' experiences of past attempts to quit may be more useful than conventional indicators of nicotine dependence in understanding their dependence.
- 1. US Department of Health and Human Services. The health consequences of smoking: nicotine addiction. A report of the Surgeon General. Rockville, Md: US Department of Health and Human Services, 1988. http://profiles.nlm.nih.gov/NN/B/B/Z/D (accessed Apr 2015).
- 2. Royal Australian College of General Practitioners. Supporting smoking cessation: a guide for health professionals. Melbourne: RACGP, 2011 [updated July 2014]. http://www.racgp.org.au/your-practice/guidelines/smoking-cessation (accessed Apr 2015).
- 3. Heatherton TF, Kozlowski LT, Frecker RC, et al. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict 1989; 84: 791-799.
- 4. Baker TB, Piper ME, McCarthy DE, et al. Time to first cigarette in the morning as an index of ability to quit smoking: implications for nicotine dependence. Nicotine Tob Res 2007; 9 Suppl 4: S555-S570.
- 5. Borland R, Yong HH, O'Connor R, et al. The reliability and predictive validity of the Heaviness of Smoking Index and its two components: findings from the International Tobacco Control Four-Country study. Nicotine Tob Res 2010; 12: S45-S50.
- 6. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991; 86: 1119-1127.
- 7. Herd N, Borland R, Hyland A. Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey. Addiction 2009; 104: 2088-2099.
- 8. Fidler JA, Shahab L, West R. Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components. Addiction 2011; 106: 631-638.
- 9. Partos TR, Borland R, Yong HH, et al. The quitting rollercoaster: how recent quitting history affects future cessation outcomes (data from the International Tobacco Control 4-country cohort study). Nicotine Tob Res 2013; 15: 1578-1587.
- 10. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: updated results, 2012–13. Canberra: ABS, 2014. (ABS Cat. No. 4727.0.55.006.)
- 11. Thomas DP. Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008. Med J Aust 2012; 197: 503-506. <MJA full text>
- 12. Butler R, Chapman S, Thomas DP, Torzillo P. Low daily smoking estimates derived from sales monitored tobacco use in six remote predominantly Aboriginal communities. Aust N Z J Public Health 2010; 34: S71-S75.
- 13. Heath DL, Panaretto K, Manessis V, et al. Factors to consider in smoking interventions for Indigenous women. Aust J Prim Health 2006; 12: 131-136.
- 14. Thomas DP, Briggs VL, Couzos S, et al. Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians. Med J Aust 2015; 202 (10 Suppl): S5-S12. <MJA full text>
- 15. Couzos S, Nicholson AK, Hunt JM, et al. Talking About The Smokes: a large-scale, community-based participatory research project. Med J Aust 2015; 202 (10 Suppl): S13-S19. <MJA full text>
- 16. International Tobacco Control Policy Evaluation Project. Surveys. http://www.itcproject.org/surveys (accessed May 2014).
- 17. Cooper J, Borland R, Yong HH, et al. To what extent do smokers make spontaneous quit attempts and what are the implications for smoking cessation maintenance? Findings from the International Tobacco Control Four Country Survey. Nicotine Tob Res 2010; 12: S51-S57.
- 18. Borland R, Yong HH, Balmford J, et al. Motivational factors predict quit attempts but not maintenance of smoking cessation: findings from the International Tobacco Control Four Country Project. Nicotine Tob Res 2010; 12 Suppl: S4-S11.
- 19. StataCorp. Stata survey data reference manual: release 13. College Station, Tex: StataCorp, 2013. http://www.stata.com/manuals13/svy.pdf (accessed Apr 2015).
- 20. Siahpush M, McNeill A, Borland R, Fong GT. Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006; 15 Suppl 3: iii71-iii75.
- 21. Fagerström K. Time to first cigarette; the best single indicator of tobacco dependence? Monaldi Arch Chest Dis 2003; 59: 91-94.
- 22. Baker TB, Breslau N, Covey L, Shiffman S. DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5. Addiction 2012; 107: 263-275.
- 23. Nicholson AK, Borland R, Davey ME, et al. Past quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers. Med J Aust 2015; 202 (10 Suppl): S20-S25. <MJA full text>
- 24. Johnston V, Thomas DP. Smoking behaviours in a remote Australian Indigenous community: the influence of family and other factors. Soc Sci Med 2008; 67: 1708-1716.
- 25. Yong HH, Borland R, Balmford J, et al. Heaviness of smoking predicts smoking relapse only in the first weeks of a quit attempt: findings from the International Tobacco Control Four-Country Survey. Nicotine Tob Res 2014; 16: 423-429.
- 26. Australian Government Department of Health and Ageing. Medicines to help Aboriginal and Torres Strait Islander people stop smoking: a guide for health workers. Canberra: Commonwealth of Australia, 2012.
- 27. Central Australian Rural Practitioners Association. CARPA standard treatment manual. 6th ed. Alice Springs: Centre for Remote Health, 2014.
- 28. McDonald SP, Maguire GP, Hoy WE. Validation of self-reported cigarette smoking in a remote Australian Aboriginal community. Aust N Z J Public Health 2003; 27: 57-60.
- 29. Gilligan C, Sanson-Fisher R, Eades S, et al. Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation. Drug Alcohol Rev 2010; 29: 35-40.
- 30. Thomas DP, Ferguson M, Johnston V, Brimblecombe J. Impact and perceptions of tobacco tax increase in remote Australian Aboriginal communities. Nicotine Tob Res 2013; 15: 1099-1106.
- 31. Thomas DP, Fitz JW, Johnston V, et al. Wholesale data for surveillance of Australian Aboriginal tobacco consumption in the Northern Territory. Tob Control 2011; 20: 291-295.
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