Indigenous health

Objectives: To describe tobacco control policies and activities at a nationally representative sample of Aboriginal community-controlled health services (ACCHSs). Design, setting and participants: The Talking About The Smokes (TATS) project used a quota sampling design to recruit 34 ACCHSs around Australia. Between April 2012 and October 2013, a representative at each ACCHS completed a survey about the service's tobacco control policies and activities. Questions about support for smoke-free policies were also included in the TATS project survey of 2435 Aboriginal and Torres Strait Islander members of the communities served by the ACCHSs. Main outcome measures: ACCHS tobacco control policies and activities. Results: Thirty-two surveys were completed, covering 34 sites. Most ACCHSs (24/32) prioritised tobacco control “a great deal” or “a fair amount”, and all services had smoke-free workplace policies. Most had staff working on tobacco control and had provided tobacco control training within the past year. A range of quit-smoking information and activities had been provided for clients and the community, as well as extra smoking cessation support for staff. There was strong support for smoke-free ACCHSs from within the Aboriginal communities, with 87% of non-smokers, 85% of ex-smokers and 77% of daily smokers supporting a complete ban on smoking inside and around ACCHS buildings. Conclusions: The high level of commitment and experience within ACCHSs provides a strong base to sustain further tobacco control measures to reduce the very high smoking prevalence in Aboriginal and Torres Strait Islander populations.

Maureen E Davey MB BS, FAFPHM · Jennifer M Hunt MPH, FAFPHM, PhD · Raylene Foster GradCertBus, DipCommunityServ(AlcoholDrugsMental Health) · Sophia Couzos FAFPHM, FACRRM, FRACGP · Anke E van der Sterren MPH, MA, BA · Jasmine Sarin BHSci(IndigHlth) · David P Thomas MB BS, PhD, FAFPHM

Objectives: To describe recall of anti-tobacco advertising (mainstream and targeted), pack warning labels, and news stories among a national sample of Aboriginal and Torres Strait Islander smokers, and to assess the association of these messages with attitudes that support quitting, including wanting to quit. Design, setting and participants: A quota sampling design was used to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. We surveyed 1643 Aboriginal and Torres Strait Islander smokers from April 2012 to October 2013. Main outcome measures: Frequency of recall of advertising and information, warning labels and news stories; recall of targeted and local advertising; attitudes about smoking and wanting to quit. Results: More smokers recalled often noticing warning labels in the past month (65%) than recalled advertising and information (45%) or news stories (24%) in the past 6 months. When prompted, most (82%) recalled seeing a television advertisement. Just under half (48%) recalled advertising that featured an Aboriginal or Torres Strait Islander person or artwork (targeted advertising), and 16% recalled targeted advertising from their community (local advertising). Frequent recall of warning labels, news stories and advertising was associated with worry about health and wanting to quit, but only frequent advertising recall was associated with believing that society disapproves of smoking. The magnitude of association with relevant attitudes and wanting to quit increased for targeted and local advertising. Conclusions: Strategies to tackle Aboriginal and Torres Strait Islander smoking should sustain high levels of exposure to anti-tobacco advertising, news stories and warning labels. More targeted and local information may be particularly effective to influence relevant beliefs and subsequently increase quitting.

Anna K Nicholson GDipPH, BPhty(Hons) · Ron Borland PhD · Jasmine Sarin BHSci(IndigHlth) · Sharon Wallace AdvDipHSci · Anke E van der Sterren MPH, MA, BA · Matthew Stevens PhD, BSc(Hons) · David P Thomas MB BS, PhD, FAFPHM

Objectives: To describe recall among a national sample of Aboriginal and Torres Strait Islander smokers and recent ex-smokers of having received advice to quit smoking and referral to non-pharmacological cessation support from health professionals, and their association with quit attempts. Design, setting and participants: The Talking About The Smokes project used a quota sampling design to recruit 1721 smokers and ex-smokers who had quit ≤ 12 months previously from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline surveys were conducted from April 2012 to October 2013. Results for daily smokers were compared with 1412 Australian daily smokers surveyed by the International Tobacco Control Policy Evaluation Project between 2006 and 2011. Main outcome measures: Participants' recall of having been: seen by a health professional in the past year, asked if they smoke, advised to quit, and referred to other cessation support services; and having made a quit attempt in the past year. Results: Compared with other Australian daily smokers, higher proportions of Aboriginal and Torres Strait Islander daily smokers saw a health professional in the past year (76% v 68.1%) and were advised to quit smoking (75% v 56.2% of those seen). Most Aboriginal and Torres Strait daily smokers who saw a health professional recalled being asked if they smoke (93%). Aboriginal and Torres Strait Islander daily smokers who had been advised to quit were more likely to have made a quit attempt in the past year than those who had not (odds ratio, 2.00; 95% CI, 1.58–2.52). Among all Aboriginal and Torres Strait Islander smokers and recent ex-smokers who had been advised to quit, 49% were given a pamphlet or brochure on how to quit, but fewer were referred to the telephone Quitline (28%), a quit-smoking website (27%) or a local quit course, group or clinic (16%). Conclusion: Most Aboriginal and Torres Strait Islander daily smokers recalled being recently advised by a health professional to quit, which was associated with making a quit attempt.

David P Thomas MB BS, PhD, FAFPHM · Pele T Bennet BHSc · Viki L Briggs BA, GDipIndigHlthProm, MPH · Sophia Couzos FAFPHM, FACRRM, FRACGP · Jennifer M Hunt MPH, FAFPHM, PhD · Kathryn S Panaretto MB BS, MPH, FAFPHM · Matthew Stevens PhD, BSc(Hons) · Ron Borland PhD

Objective: To examine smoking among Aboriginal and Torres Strait Islander staff of Aboriginal community-controlled health services (ACCHSs). Design, setting and participants: The Talking About The Smokes (TATS) project surveyed 374 Aboriginal and Torres Strait Islander staff at a national sample of 31 ACCHSs, from April 2012 to October 2013. We made comparisons with adult participants in the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and with 1643 smokers in a community sample of 2522 Aboriginal and Torres Strait Islander people also surveyed in the TATS project. Main outcome measures: Smoking status, smoking behaviour at work, quitting behaviour, attitudes and beliefs about smoking and quitting. Results: Aboriginal and Torres Strait Islander ACCHS staff had a lower smoking prevalence than among all Aboriginal and Torres Strait Islander adults surveyed in the NATSISS (38% v 49.8%), but this difference was smaller when compared with only employed adults (38% v 44.8%). Staff smokers had higher odds than smokers in their communities of ever trying to quit (odds ratio [OR], 2.1; 95% CI, 1.1–3.7), of having often noticed anti-smoking advertising (OR, 2.8; 95% CI, 1.4–5.6), and of having used stop-smoking medications (OR, 3.0; 95% CI, 1.6–5.7), often with the support of their ACCHS. There was a significant association (P < 0.001) between the smoking status of Aboriginal and Torres Strait Islander staff and their confidence in talking to others about smoking and quitting; ex-smokers were most likely to report being confident. Most Aboriginal and Torres Strait Islander staff who smoked (74%) agreed that being a non-smoker sets a good example to patients at their health service, and most did not smoke with patients or at work where patients could see them. Conclusion: Smoking prevalence among Aboriginal and Torres Strait Islander ACCHS staff is only modestly lower than among other employed Aboriginal and Torres Strait Islander people. Given that ex-smokers feel more confident to help others quit than any other group, smoking cessation in ACCHS staff is a useful contributor to reducing community smoking rates.

David P Thomas MB BS, PhD, FAFPHM · Maureen E Davey MB BS, FAFPHM · Kathryn S Panaretto MB BS, MPH, FAFPHM · Jennifer M Hunt MPH, FAFPHM, PhD · Matthew Stevens PhD, BSc(Hons) · Anke E van der Sterren MPH, MA, BA

PAT ANDERSON, chair of the Lowitja Institute, Australia's National Institute for Aboriginal and Torres Strait Islander Health Research, provides generous praise to the authors of this work for their valuable contribution to research and practice of empowerment in Aboriginal health (http://www.lowitja.org.au/promoting-aboriginal-health-family-wellbeing-empowerment-approach). When you read this text you will find that the praise is well deserved. However, it would have been handy if it had also ...

Dameyon Bonson