Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

Abstract

BackgroundTobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014–15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities.MethodsMEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement.ResultsTwenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or ‘pubs, clubs and restaurants’.ConclusionsThere is limited Indigenous-specific evidence for most tobacco interventions. A ‘comprehensive approach’ incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0520-9) contains supplementary material, which is available to authorized users.

Changes in the age young Aboriginal and Torres Strait Islander people start smoking, 2002–2015

“…5,21 It is not possible to determine if any individual component has been more effective than others, but measures that are Indigenous-led and culturally tailored are identified as particularly important. 21,23 A greater understanding of what works for young people of different ages is needed to design programs that continue to prevent smoking throughout adolescence and into adulthood. 23 Our results may indicate a trend towards delayed smoking initiation, with the largest increase in never smoking since 2002 among 18-19-year-olds and more moderate changes among 20-24-year-olds.…”

“…21,23 A greater understanding of what works for young people of different ages is needed to design programs that continue to prevent smoking throughout adolescence and into adulthood. 23 Our results may indicate a trend towards delayed smoking initiation, with the largest increase in never smoking since 2002 among 18-19-year-olds and more moderate changes among 20-24-year-olds. As shown previously for both Indigenous and non-Indigenous people 5 , we found that the majority of Indigenous adolescents and young adults who have ever smoked regularly started smoking before age 18.…”

“…5 Reducing smoking prevalence involves supporting existing smokers to quit and preventing smoking initiation. Most regular smoking begins during adolescence and young adulthood, defined in this paper as 10-24 years: early adolescence (10)(11)(12)(13)(14), late adolescence (15)(16)(17)(18)(19) and young adulthood (20)(21)(22)(23)(24). 6 Almost all (99%) daily smokers begin smoking before age 26.…”

What ngidhi yinaaru nhal yayi (this woman told me) about smoking during pregnancy

“…We therefore hit a dilemma: what cessation support should even be offered? Systematic reviews on Aboriginal tobacco control have concluded that there is limited evidence of effective programs for Aboriginal and Torres Strait Islander people in general as well as during pregnancy …”

Reducing smoking in Australia: how to include Aboriginal and Torres Strait Islander people

“…Little research considers the appropriateness and transferability of initiatives elsewhere to Aboriginal and Torres Strait Islander contexts (Van der Sterren et al 2016), while there is a need for Indigenous-specific research regarding: the impact of pricing measures; interventions to reduce tobacco use among adolescents and pregnant women; the effects of the introduction of smoking bans in prisons; and linguistically diverse Indigenous people. There is also a need for Indigenous-specific evidence regarding interventions using social media and mobile applications, electronic cigarettes, and how to protect communities from industry interference (Chamberlain et al 2017). Robertson et al's 2015 systematic review of trends in Indigenous Australian tobacco research from 2004 to 2013 found that, despite a surge in research output in 2008 relating to Indigenous tobacco control, there were still few intervention studies available to guide future efforts.…”