Smoking cessation and tobacco prevention in Indigenous populations

Abstract

This article systematically reviews 91 smoking cessation and tobacco prevention studies tailored for Indigenous populations around the world, with a particular focus on Aboriginal and Torres Strait Islander populations in Australia. We identified several components of effective interventions, including the use of multifaceted programs that simultaneously address the behavioural, psychological and biochemical aspects of addiction, using resources culturally tailored for the needs of individual Indigenous populations. Pharmacotherapy for smoking cessation was effective when combined with culturally tailored behavioural interventions and health professional support, though it is generally underused in clinical practice. From a policy perspective, interventions of greater intensity, with more components, were more likely to be effective than those of lower intensity and shorter duration. For any new policy it is important to consider community capacity building, development of knowledge, and sustainability of the policy beyond guided implementation. Future research should address how the intervention can be supported into standard practice, policy, or translation into the front-line of clinical care. Investigations are also required to determine the efficacy of emerging therapies (such as e-cigarettes and the use of social media to tackle youth smoking), and under-researched interventions that hold promise based on nonIndigenous studies, such as the use of Champix. We conclude that more methodologically rigorous investigations are required to determine components of the less-successful interventions to aid future policy, practice and research initiatives. (Australian Bureau of Statistics 2013, 2014b. These values also vary among population sub-groups. For example, in some remote Australian communities the tobacco prevalence estimate is as high as 83 percent (MacLaren et al. 2010). Smoking is also higher among Indigenous Australian pregnant women with up to 65 percent reported to be using tobacco (Carson et al. 2013) and children aged 15-24 years with 39 percent smoking daily (Australian Bureau of Statistics 2011). As a result, a significant disparity in morbidity and premature mortality between these two groups ensues, with Indigenous people bearing the higher burden. This disparity is often referred to as 'the gap' (Knibbs and Sly 2014;Russell 2013). Smoking cessation and tobacco prevention in indigenous populationsPopulation-wide interventions targeted at adult smokers (Cahill et al. 2013; Stead and Lancaster 2012) and young people (Brinn et al. 2010; Carson et al. 2011) are known to help smokers quit and prevent the uptake of tobacco use. However, these broad population-level standardised interventions appear to have had little impact on altering the tobacco prevalence gap between Indigenous and non-Indigenous. The most recent statistics from the Australian Aboriginal and TSI Health Survey found a decrease in daily smoking rates over the past decade for Aboriginal and TSI Australians, which was compara...

Collective reflexivity in social marketing through ethnographic film-making: The Yolngu story of tobacco in Yirrkala, Australia

“…Practically, we identify how ethnographic film-making can act as a vehicle for stimulating processes of collective reflexivity that offer an alternative pathway to mainstream approaches working with Indigenous communities. Social marketers have argued that culturally appropriate work is important to effectively combat public health issues within minority communities (Carson et al, 2014;Gould et al, 2016;Spotswood and Tapp, 2013). Our article more deeply examines the sociocultural bridging and bonding capacity of ethnographic initiatives in the present social marketing context, especially given the criticisms of traditional public health approaches to Indigenous welfare that only focus on the individual consumer of health services (Humphery, 2001;Pholi et al, 2009).…”

“…Later, in the 20th century, government-funded missionaries used tobacco as payment for labour, resulting in large numbers of Indigenous people becoming addicted (Cole, 1979). The historical evolution of tobacco smoking among Indigenous populations away from its exclusive use by clan elders to its more widespread use over the past seven decades can be linked to these government-subsidised mission programmes (Carson et al, 2014).…”