The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting

Abstract

BackgroundAustralian Aboriginal and Torres Strait Islander peoples (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the outcome of a study that aimed to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program.MethodsA randomised controlled trial of Aboriginal researcher delivered tailored smoking cessation counselling during face-to-face visits, aiming for weekly for the first four weeks, monthly to six months and two monthly to 12 months. The control (“usual care”) group received routine care relating to smoking cessation at their local primary health care service. Data collection occurred at enrolment, six and 12 months. The primary outcome was self-reported smoking cessation with urinary cotinine confirmation at final follow-up (median 13 (interquartile range 12–15) months after enrolment).ResultsParticipants in the intervention (n = 55) and usual care (n = 108) groups were similar in baseline characteristics, except the intervention group was slightly older. At final follow-up the smoking cessation rate for participants assigned to the intervention group (n = 6; 11%), while not statistically significant, was double that of usual care (n = 5; 5%; p = 0.131). A meta-analysis of these findings and a similarly underpowered but comparable study of pregnant Indigenous Australian women showed that Indigenous Australian participants assigned to the intervention groups were 2.4 times (95% CI, 1.01-5.5) as likely to quit as participants assigned to usual care.ConclusionsCulturally appropriate, multi-dimensional Indigenous quit smoking programs can be successfully implemented in remote primary health care. Intensive one-on-one interventions with substantial involvement from Aboriginal and Torres Strait Islander workers are likely to be effective in these settings.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12608000604303).

Smoking cessation advice and non‐pharmacological support in a national sample of Aboriginal and Torres Strait Islander smokers and ex‐smokers

“…A meta‐analysis of two randomised controlled trials showed intensive cessation counselling programs for Aboriginal and Torres Strait Islander smokers were effective in increasing cessation 26 . We found that most people who attended special cessation programs said they were specifically designed for Aboriginal and Torres Strait Islander peoples.…”

Substance misuse intervention research in remote Indigenous Australian communities since the NHMRC ‘Roadmap’

“…Outcomes in context: Summarised and highlighted in Table , none of the evaluations of implementation reported statistically significant effects attributable to the intervention 22–24 . However, meta‐analysis of the pooled data from two (A1 and A2) found a significant effect of intensive health worker support on tobacco cessation 24 . Program A1 established that pregnant women who had already quit smoking independently of an intervention remained non‐smokers at the end of their pregnancy 25 .…”

“…Unfortunately, none of the studies were able to demonstrate a large or socially significant reduction in levels of use of the targeted substance, nor a clear effect attributable to the intervention. Low fidelity of implementation, 30 weak study designs 36 and inevitably small sample sizes 24 undermined the utility of the results of most studies.…”

Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence

“…Experimental designs such as these are only possible when considered during program development and implementation, and if relevant to and supported by participating communities. Such evaluations may not be appropriate or required in every setting, particularly in the case of complex public health interventions or when the evaluation is conducted with a small sample or in one setting, but as they provide a high level of evidence, they must be given due consideration during program design 12 . Calls for their use must also be based on an assessment of their utility, feasibility, and value to service agencies and communities during program planning.…”