Culturally tailored tobacco control: Aboriginal community perspectives in Sydney, Australia.

INTRODUCTION: A community-based project was developed to support quit attempts and denormalise smoking in Aboriginal communities. This qualitative study evaluates the effectiveness of project strategies, messages and the partnership process, and explores impacts observed by Aboriginal community members, complementing findings from a quantitative evaluation. METHODS: The study comprised five focus groups (40 participants) and 14 in-depth interviews (with 15 community members). Data were analysed thematically by manual and NVivo software methods. RESULTS: Results demonstrate that the project attracted community attention, was well recalled and messages were considered convincing and persuasive. Participants reported being more likely to quit and to discuss smoking with family and friends, and noticed that many people were quitting. Participants observed an increase in asking people not to smoke in the home and fewer people smoking at events, but noted that many smokers struggled to stay quit. The partnership and participation of Aboriginal Health Workers were viewed as crucial. CONCLUSION: The qualitative findings reinforce quantitative evaluation findings suggesting that the project contributed to denormalising smoking and motivating quit attempts. SO WHAT: The evaluation provided insight into how the project changed attitudes and motivated community members to make quit attempts and provided ideas to meet the ongoing challenge.

Evaluating an Aboriginal tobacco social marketing project in Sydney, Australia.

INTRODUCTION: A partnership between three Aboriginal Community Controlled Organisations and a mainstream health service was formed to develop, implement and evaluate a comprehensive and culturally appropriate social marketing project which aimed to encourage smokers to quit smoking. The project also supported quit attempts and promoted denormalisation of smoking. METHODS: The project was evaluated through baseline (n = 427) and follow-up (n = 611) surveys carried out face-to-face with Aboriginal and/or Torres Strait Islander participants 18 years and older recruited through convenience sampling at community events and venues during 2010-2011 and 2015. RESULTS: The proportion of participants who had made one or more quit attempts increased significantly between baseline and follow-up surveys (54%, 101 out of 187; vs 64%, 189 out of 297; P < 0.05). Participants who had intended to quit within 6 months (AOR, 3.29; 95% CI 1.90-5.68; P < 0.01); and participants disagreeing with the statement "I don't mind if people smoke inside my home" (AOR, 1.74; 95% CI 1.06-2.84; P < 0.05) were significantly more likely to have made one or more quit attempts compared to the respective reference groups. CONCLUSION: Study findings demonstrate that the project was associated with increased quit attempts. Intention to quit and attitude were found to be the predictors of making a quit attempt. SO WHAT?: Many studies suggest the need to denormalise smoking; this study demonstrated both change in attitudes and an increase in quit attempts. It is recognised that many quit attempts may be needed for long-term smoking cessation.

Smoking among Aboriginal adults in Sydney, Australia.

Issue addressed Tobacco consumption contributes to health disparities among Aboriginal Australians who experience a greater burden of smoking-related death and diseases. This paper reports findings from a baseline survey on factors associated with smoking, cessation behaviours and attitudes towards smoke-free homes among the Aboriginal population in inner and south-western Sydney. Methods A baseline survey was conducted in inner and south-western Sydney from October 2010 to July 2011. The survey applied both interviewer-administered and self-administered data collection methods. Multiple logistic regression was performed to determine the factors associated with smoking. Results Six hundred and sixty-three participants completed the survey. The majority were female (67.5%), below the age of 50 (66.6%) and more than half were employed (54.7%). Almost half were current smokers (48.4%) with the majority intending to quit in the next 6 months (79.0%) and living in a smoke-free home (70.4%). Those aged 30-39 years (AOR 3.28; 95% CI: 2.06-5.23) and the unemployed (AOR 1.67; 95% CI: 1.11-2.51) had higher odds for current smoking. Participants who had a more positive attitude towards smoke-free homes were less likely to smoke (AOR 0.79; 95% CI: 0.74-.85). Conclusions A high proportion of participants were current smokers among whom intention to quit was high. Age, work status and attitudes towards smoke-free home were factors associated with smoking. So what? The findings address the scarcity of local evidence crucial for promoting cessation among Aboriginal tobacco smokers. Targeted promotions for socio-demographic subgroups and of attitudes towards smoke-free homes could be meaningful strategies for future smoking-cessation initiatives.

Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals.

OBJECTIVE: To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. METHODS: Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. RESULTS: There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. CONCLUSIONS AND IMPLICATIONS: The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

Evaluation of a comprehensive tobacco control project targeting Arabic-speakers residing in south west Sydney, Australia.

Tobacco control is a health promotion priority, but there is limited evidence on the effectiveness of campaigns targeting culturally and linguistically diverse (CALD) populations. Being the largest population of non-English-speaking smokers residing in New South Wales (NSW), Australia, Arabic-speakers are a priority population for tobacco control. We report findings from baseline and post-intervention cross-sectional telephone surveys evaluating a comprehensive social marketing campaign (SMC) specifically targeting Arabic-speakers residing in south west Sydney, NSW. The project was associated with a decline in self-reported smoking prevalence from 26% at baseline to 20.7% at post (p < 0.05) and an increase in self-reported smoke-free households from 67.1% at baseline to 74.9% at post (p < 0.05). This paper contributes evidence that comprehensive SMCs targeting CALD populations can reduce smoking prevalence and influence smoking norms in CALD populations.

Tobacco control priorities for Arabic speakers: key findings from a baseline telephone survey of Arabic speakers residing in Sydney's south-west.

ISSUE ADDRESSED: The Arabic-speaking population is a priority for tobacco control in Sydney's south-west. Current smoking prevalence and smokers' preferences for evidence-based cessation therapies are reported for this population. METHODS: A telephone survey of Arabic speakers conducted in Sydney's south-west between August and November 2004 included: utilisation of tobacco products, tobacco and health knowledge, quit attempts and likelihood to use evidence-based cessation strategies. RESULTS: A 70% response rate was achieved (n=1,102). Twenty-six per cent of respondents (95% CI 23.5-28.7) self-reported being current smokers. Logistic regression analysis demonstrated that poor knowledge of the harms of smoking (AOR=7.50, 95% CI 3.20-17.59), being male (AOR=2.63, 95% CI 1.89-3.65), being aged between 40 and 59 (AOR=1.44, 95% CI 1.06-1.96) and non-tertiary educated (AOR=1.44, 95% CI 1.06-1.97) were independent predictors of self-reported smoking. Smokers' preferences for evidence-based cessation strategies included: vouchers for discounted nicotine replacement therapy (NRT) (58.8%, 95% CI 52.9-64.6), standard self-help booklet (56.6%, 95% CI 50.7-62.4) and tailored self-help written materials (mailed) (54.0%, 95% CI 48.1- 59.9). More than one-third of all current cigarette smokers (39.4%, n=108, 95% CI 33.6-45.2) indicated they had made a quit attempt in the past 12 months. CONCLUSIONS: Well-designed trials of efficacy for preferred evidence-based strategies, particularly among middle-aged male Arabic-speaking smokers, appear warranted prior to policy development and implementation.

Subsidised nicotine replacement therapy in a community pharmacy setting.

ISSUES ADDRESSED: Nicotine replacement therapies are effective, but are mostly under-utilised and often not used for an appropriate duration. The paper reports on a pilot project that used subsidies for NRT as a means to engage community pharmacists to deliver tobacco cessation to the Arabic-speaking community. METHOD: Arabic-speaking community pharmacists were recruited through direct mail-outs and trained in tobacco cessation brief intervention. Fifteen selected pharmacies recruited Arabic smokers through their pharmacies. Pharmacy follow-up was conducted three months after the program was implemented. RESULTS: A total of 65 participants attended the seminar. A total of 31 pharmacy customers received at least one packet of subsidised NRT patches. Twenty (64.5%) clients received both the first and second subsidised pack. Fifteen clients continued to use patches after the third packet, however only three clients continued the patches to the eighth pack. CONCLUSION: The pilot was successful in improving recruitment of pharmacies into training for smoking cessation counselling as well as engaging community pharmacists to deliver tobacco cessation intervention with small incentive.