1
|
Selvarajah S, Corona Maioli S, Deivanayagam TA, de Morais Sato P, Devakumar D, Kim SS, Wells JC, Yoseph M, Abubakar I, Paradies Y. Racism, xenophobia, and discrimination: mapping pathways to health outcomes. Lancet 2022; 400:2109-2124. [PMID: 36502849 DOI: 10.1016/s0140-6736(22)02484-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/06/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
Collapse
Affiliation(s)
- Sujitha Selvarajah
- Institute for Global Health, University College London, London, UK; St George's Hospital NHS Foundation Trust, London, UK.
| | | | - Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Seoul National University, Seoul, South Korea
| | - Jonathan C Wells
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Marcella Yoseph
- Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne VIC, Australia
| |
Collapse
|
2
|
Cunningham FC, Murphy MG, Ward G, Fagan R, Arley B, Hornby-Turner YC, d'Abbs PH. Impact of an Aboriginal and Torres Strait Islander brief intervention training program on health staff participants' own health behaviours: smoking, nutrition and physical activity. Health Promot J Austr 2022; 33 Suppl 1:235-245. [PMID: 35661321 DOI: 10.1002/hpja.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022] Open
Abstract
ISSUE Little research has been conducted on the impact of Aboriginal and Torres Strait Islander brief intervention training programs on health staff participants' own health behaviours. Through the Queensland B.strong program (2017-2020), brief intervention training in smoking cessation, nutrition and physical activity was provided to the Aboriginal and Torres Strait Islander health workforce and other health and community professionals. This study examined the program's impact on participants' own health behaviours. METHODS Data were collected through four surveys (pre-and post-training workshop, and 3-month and 6-month follow-up) of the 1,131 participants in B.strong training workshops from June 2017 to August 2019. Surveys included items on participants' own health behaviours. Pre- and post-workshop surveys were paper-based, and follow-up surveys were completed online. For the analysis of data reported in this paper, paired-samples t-tests were used to assess changes between pre-workshop and 3-month follow-up. RESULTS Statistically significant improvements were found between pre-workshop and 3-month follow-up in the number of serves of vegetables or legumes/beans eaten per day, the number of serves of fruit eaten per day, and in time spent in physical activity. However, there was: no statistically significant change in smoking status, with baseline rates being relatively low; a statistically significant increase in consumption of sugary drinks, and of take-away foods; a non-significant increase in consumption of snack foods; and no significant change in sedentary behaviour of participants. CONCLUSION While some positive changes in participants' own health behaviours in nutrition and physical activity were associated with the B.strong program, there was no change in their smoking behaviour. SO WHAT This study found that some improvements in participants' own health behaviours were associated with the B.strong program. This research may inform future Indigenous brief intervention training programs and health services on how to promote healthy behaviours for health staff themselves.
Collapse
Affiliation(s)
- Frances C Cunningham
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| | - Majella G Murphy
- Molly Wardaguga Research Centre, Charles Darwin University, Level 11, East Tower, 410 Ann St., Brisbane City Qld, Australia
| | - Grace Ward
- Diabetes Australia Queensland, 29 Finchley St., Milton Qld 4064, Australia
| | - Royden Fagan
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| | - Brian Arley
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| | - Yvonne C Hornby-Turner
- College of Medicine and Dentistry, James Cook University, Cairns Qld Australia, Room 003A, E Block, Health and Sciences Building, Nguma-Bada Campus, James Cook University, McGregor Rd., Smithfield Qld, Australia
| | - Peter H d'Abbs
- Menzies School of Health Research, John Mathews Building (Building 58), Royal Darwin Hospital Campus, Rocklands Drive, Casuarina NT, Australia
| |
Collapse
|
3
|
Gendall P, Hoek J, Stanley J, Jenkins M, Every-Palmer S. Changes in Tobacco Use During the 2020 COVID-19 Lockdown in New Zealand. Nicotine Tob Res 2021; 23:866-871. [PMID: 33515223 PMCID: PMC7928623 DOI: 10.1093/ntr/ntaa257] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/01/2020] [Indexed: 01/15/2023]
Abstract
Introduction New Zealand’s response to the COVID-19 pandemic was one of the most restrictive lockdowns of any country, inevitably causing stress for many people. Because situations that increase stress and anxiety are associated with higher smoking prevalence, we examined self-reported smoking before and during the lockdown, and analyzed factors associated with reported changes in cigarette consumption. Aims and Methods We conducted an online panel survey of a demographically representative sample of 2010 adult New Zealanders during the COVID-19 lockdown; the final, weighted sample included 261 daily smokers and 71 weekly smokers. We measured psychological distress and anxiety, as well as situational factors, tobacco consumption, and demographic attributes. Results Nearly half of daily smokers reported smoking more during than before the lockdown, on average, an increase of six cigarettes a day; increased daily cigarette consumption was associated with loneliness and isolation. Most weekly smokers reported either that their smoking during the lockdown had not changed or had slightly reduced. Conclusions Smoking cessation services need to anticipate that unexpected disruptions, such as pandemic lockdowns, may be associated with increased daily tobacco consumption, and that this increase may be sustained after lockdown. While public health responses to pandemics predictably focus on immediate and obvious consequences, interventions to support recent quitters and those making quit attempts should also form a key component of pandemic planning. Implications As governments introduce unprecedented measures to manage COVID-19, they need also to consider other public health risks, such as increased smoking among current smokers or relapse among recent quitters. Evidence that loneliness was associated with increased smoking during a lockdown suggests a need for cessation out-reach strategies that promote and support smoke-free practices.
Collapse
Affiliation(s)
- Philip Gendall
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Mathew Jenkins
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| |
Collapse
|
4
|
Bond C, Brough M, Willis J, Stajic J, Mukandi B, Canuto C, Springer S, Askew D, Angus L, Lewis T. Beyond the pipeline: a critique of the discourse surrounding the development of an Indigenous primary healthcare workforce in Australia. Aust J Prim Health 2020; 25:389-394. [PMID: 31619320 DOI: 10.1071/py19044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/11/2019] [Indexed: 11/23/2022]
Abstract
A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of 'supply', is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just 'supply'. The pipeline metaphor is disrupted with concerns about a range of other 'gaps' - gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline.
Collapse
Affiliation(s)
- Chelsea Bond
- The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia; and Corresponding author.
| | - Mark Brough
- Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Jon Willis
- The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia
| | - Janet Stajic
- The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia
| | - Bryan Mukandi
- The University of Queensland School of Medicine, Brisbane, Qld 4072, Australia
| | - Condy Canuto
- The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia
| | - Shannon Springer
- Bond University, 14 University Drive, Robina, Qld 4226, Australia
| | - Deborah Askew
- The University of Queensland School of Medicine, Brisbane, Qld 4072, Australia
| | - Lynnell Angus
- The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia
| | - Tara Lewis
- The University of Queensland Poche Centre for Indigenous Health, Brisbane, Qld 4072, Australia
| |
Collapse
|
5
|
Does Smokers’ Self-Construal Moderate the Effect of (Self-)persuasion on Smoking? HEALTH PSYCHOLOGY BULLETIN 2019. [DOI: 10.5334/hpb.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
6
|
Wright A. Survey of Aboriginal smokers' and ex-smokers' knowledge, attitudes and behaviours in Central Australia 2016-2017. Aust J Rural Health 2018; 26:251-257. [PMID: 30008176 DOI: 10.1111/ajr.12431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine tobacco knowledge, attitudes and behaviours of community members in Central Australia and to compare these by participant's location (town or remote community). DESIGN Community-based survey of 165 smokers and recent ex-smokers. OUTCOME MEASURES Knowledge was assessed using responses to questions on the health risk of smoking (e.g. lung cancer) and knowledge of quit support services. Attitudes towards smoking were assessed using statements that asked participant whether they agreed or disagreed. Smoking behaviours were assessed by asking participants about quit attempts, cigarettes per day and time to first cigarette (used to calculate the heaviness of smoking index). RESULTS There were high levels of knowledge about most common diseases associated with smoking, including cancer (93%) and heart disease (89%). There was less knowledge about quit support services that are available through telephone (69%), online (27%) and apps (32%). Responses to attitude statements were suggestive of the normalised practices towards smoking in town and remote participants, with remote participants more likely to disagree that 'ok to smoke close to a building' and to disagree 'if I had my time over again I would not have started'. Over 75% of the participants had attempted to quit smoking and 55% had a sustained quit attempt (>1 month). CONCLUSION There are greater challenges to reduce smoking in remote areas due to the social and communal practices of smoking and in providing service needs that encourage quit attempts. This supports the need for continued and increased investment for targeted tobacco control by remote health services.
Collapse
Affiliation(s)
- Alyson Wright
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
7
|
Topp SM, Edelman A, Taylor S. "We are everything to everyone": a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. Int J Equity Health 2018; 17:67. [PMID: 29848331 PMCID: PMC5977558 DOI: 10.1186/s12939-018-0779-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health policy in Australia positions Aboriginal and Torres Strait Islander Health Workers (AHWs) as central to improving Aboriginal and Torres Strait Islander peoples' health, with high expectations of their contribution to closing the gap between Indigenous and non-Indigenous health outcomes. Understanding how AHWs' governance and accountability relationships influence their ability to address such health inequities has policy, programme and ethical significance. We sought to map the evidence of AHWs' experiences of accountability in the Australian health system. METHODS We followed an adapted qualitative systematic review process to map evidence on accountability relations in the published literature. We sought empirical studies or first-person accounts describing AHWs' experiences of working in government or Aboriginal community-controlled services anywhere in Australia. Findings were organised according to van Belle and Mayhew's four dimensions of accountability - social, political, provider and organisational. RESULTS Of 27 included studies, none had a primary focus on AHW governance or AHWs' accountability relationships. Nonetheless, selected articles provided some insight into AHWs' experiences of accountability across van Belle and Mayhew's four dimensions. In the social dimension, AHWs' sense of connection and belonging to community was reflected in the importance placed on AHWs' cultural brokerage and advocacy functions. But social and cultural obligations overlapped and sometimes clashed with organisational and provider-related accountabilities. AHWs described having to straddle cultural obligations (e.g. related to gender, age and kinship) alongside the expectations of non-Indigenous colleagues and supervisors which were underpinned by 'Western' models of clinical governance and management. Lack of role-clarity stemming from weakly constituted (state-based) career structures was linked to a system-wide misunderstanding of AHWs' roles and responsibilities - particularly the cultural components - acting as a barrier to AHWs working to their full capacity for the benefit of patients, broader society and their own professional satisfaction. CONCLUSIONS In literature spanning different geographies, service domains and several decades, this review found evidence of complexity in AHWs' accountability relationships that both affects individual and team performance. However, theoretically informed and systematic investigation of accountability relationships and related issues, including the power dynamics that underpin AHW governance and performance in often diverse settings, remains limited and more work in this area is required.
Collapse
Affiliation(s)
- Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Drive, Townsville, QLD 4810 Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC 3010 Australia
| | - Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Drive, Townsville, QLD 4810 Australia
| | - Sean Taylor
- Torres and Cape Hospital and Health Service, Community Wellness Centre, Thursday Island Hospital Campus, Thursday Island, QLD 4875 Australia
| |
Collapse
|
8
|
Jiang H, Li S, Yang J. Work Stress and Depressive Symptoms in Fishermen With a Smoking Habit: A Mediator Role of Nicotine Dependence and Possible Moderator Role of Expressive Suppression and Cognitive Reappraisal. Front Psychol 2018; 9:386. [PMID: 29632504 PMCID: PMC5879124 DOI: 10.3389/fpsyg.2018.00386] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
This study examined pathways of influence between work stress, depressive symptoms, nicotine dependence, expressive suppression, and cognitive reappraisal in fishermen with smoking habits in Qionghai, Hainan province, China (N = 1068). These fishermen responded to multiple assessments a week before leaving on a deep-sea fishing trip, including a Mental Stressor Investigation Questionnaire (MSIQ), the Center for Epidemiological Studies Depression Scale (CES-D), the Russell Reason for Smoking Questionnaire (RRSQ), and an Emotion Regulation Questionnaire (ERQ). Structural equation modeling (SEM) analyses of the collected data in Mplus 7 showed that work stress and nicotine dependence were independent predictors of depressive symptoms. The relationship between work stress and depressive symptoms was found to be partially mediated by nicotine dependence and be moderated by cognitive reappraisal. The evidence suggests it advantageous to examine the need of work stress, nicotine dependence, and cognitive reappraisal when attempting to understand depressive symptoms in fishermen with a smoking habit. These findings suggest that improving nicotine dependence through work stress management and training in cognitive reappraisal could be utilized as effective modalities for improving depressive symptoms.
Collapse
Affiliation(s)
- Hongjuan Jiang
- Department of Psychology, Hainan Medical University, Haikou, China
| | - Sailan Li
- Hainan Anning Hospital, Haikou, China
| | - Juan Yang
- Department of Psychology, Hainan Medical University, Haikou, China
| |
Collapse
|
9
|
Conway J, Tsourtos G, Lawn S. The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: a multiple case study. BMC Health Serv Res 2017; 17:319. [PMID: 28468612 PMCID: PMC5415721 DOI: 10.1186/s12913-017-2265-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/25/2017] [Indexed: 11/24/2022] Open
Abstract
Background The inequality in health outcomes between Indigenous (Throughout the paper, the term Indigenous will be used to represent both Aboriginal Australians and Torres Strait Islander Australians.) and non-Indigenous Australians continues to be a major public health issue. Chronic conditions are responsible for the majority of the gap in life expectancy for this population. Evidence suggests that chronic condition management models focusing on self-management have led to improved health outcomes in Indigenous populations. The Flinders Closing the Gap Program (FCTGP) is a chronic condition care planning tool which aims to engage Indigenous people in self-managing their chronic conditions. Indigenous health workers (IHWs) can provide culturally appropriate self-management support; however there is paucity in current literature describing specific barriers and facilitators that they may experience when attempting to deliver this support. This study aimed to explore IHWs’ perceptions of the effectiveness and appropriateness of the FCTGP, as an evidence-based example of self-management support, and to explore the barriers and facilitators that IHWs experience in their workplace and communities in providing self-management support. Methods In-depth interviews were undertaken with five IHWs, drawn from five different states in Australia. Their selection was aided by key informants from the FCTGP training unit. Interviews were recorded and transcribed verbatim, and were analysed using thematic analysis. Results The following themes were identified. IHWs reported that the FCTGP was appropriate, flexible and acceptable in their communities. Facilitators included factors improving client and worker empowerment, and activities around sharing knowledge. Barriers included competing priorities that clients experience relating to social determinants of health, and negative experiences within mainstream health services. IHW burnout from time pressures, lack of support, and high staff turnover were also considered important barriers. Conclusions This study contributes an insight into the experiences of IHWs who are considered important stakeholders in implementation and sustainability of chronic condition management programs, including the FCTGP. Recommendations focus on supporting and supplementing the role of IHWs and identify the FCTGP as a facilitator in providing self-management support to a population with complex needs.
Collapse
Affiliation(s)
| | - George Tsourtos
- Discipline of Public Health, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, Margaret Tobin Centre, PO Box 2100, Adelaide, South Australia, 5001, Australia.
| |
Collapse
|
10
|
Arjunan P, Poder N, Welsh K, Bellear L, Heathcote J, Wright D, Millen E, Spinks M, Williams M, Wen LM. Smoking among Aboriginal adults in Sydney, Australia. Health Promot J Austr 2017; 27:66-69. [PMID: 26235612 DOI: 10.1071/he15020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Punitha Arjunan
- Health Promotion Service, South Western Sydney Local Health District, Eastern Campus, Liverpool Hospital, Liverpool BC, NSW 1871, Australia
| | - Natasha Poder
- Health Promotion Service, South Western Sydney Local Health District, Narellan Community Health Centre, 14 Queen Street, Narellan, NSW 2567, Australia
| | - Kerry Welsh
- Health Promotion Service, South Western Sydney Local Health District, Bankstown Community Health, 5/39 Stanley Street, Bankstown, NSW 2200, Australia
| | - LaVerne Bellear
- Aboriginal Medical Service Redfern, 36 Turner Street, Redfern, NSW 2016, Australia
| | - Jeremy Heathcote
- Babana Aboriginal Men's Group Inc., 37-47St John's Road, Glebe, NSW 2016, Australia
| | - Darryl Wright
- Tharawal Aboriginal Corporation, 187 Riverside Drive, Airds, NSW 2560, Australia
| | - Elizabeth Millen
- Health Promotion Service, South Western Sydney Local Health District, Bankstown Community Health, 5/39 Stanley Street, Bankstown, NSW 2200, Australia
| | - Mark Spinks
- Babana Aboriginal Men's Group Inc., 37-47St John's Road, Glebe, NSW 2016, Australia
| | - Mandy Williams
- Health Promotion Service, South Western Sydney Local Health District, Eastern Campus, Liverpool Hospital, Liverpool BC, NSW 1871, Australia
| | - Li Ming Wen
- Health Promotion Service, Sydney Local Health District, Level 9 North, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia
| |
Collapse
|
11
|
Campbell D. Economies through Application of Nonmedical Primary-Preventative Health: Lessons from the Healthy Country Healthy People Experience of Australia's Aboriginal People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:400. [PMID: 27482574 PMCID: PMC4847062 DOI: 10.3390/ijerph13040400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/24/2016] [Indexed: 12/02/2022]
Abstract
The World Health Organization reports noncommunicable disease as a global pandemic. While national and international health research/policy bodies, such as the World Health Organization and the Australian Institute of Health and Welfare, emphasize the importance of preventative health, there is a continuing distortion in the allocation of resources to curative health as a result of government failure. Government failure is, in part, the result of a political response to individual preference for certainty in receiving treatment for specific health conditions, rather than the uncertainty of population-based preventative intervention. This has led to a failure to engage with those primary causative factors affecting chronic disease, namely the psychosocial stressors, in which the socioeconomic determinants are an important component. Such causal factors are open to manipulation through government policies and joint government-government, government-private cooperation through application of nonmedical primary-preventative health policies. The health benefits of Aboriginal people in traditional land management, or caring-for-country, in remote to very remote Australia, is used to exemplify the social benefits of nonmedical primary-preventative health intervention. Such practices form part of the "healthy country, health people" concept that is traditionally relied upon by Indigenous peoples. Possible health and wider private good and public good social benefits are shown to occur across multiple disciplines and jurisdictions with the possibility of substantial economies. General principles in the application of nonmedical primary-preventative health activities are developed through consideration of the experience of Afboriginal people participation in traditional caring-for-country.
Collapse
|
12
|
Nicholson AK, Borland R, Bennet PT, Sterren AE, Stevens M, Thomas DP. Personal attitudes towards smoking in a national sample of Aboriginal and Torres Strait Islander smokers and recent quitters. Med J Aust 2015; 202:S51-6. [DOI: 10.5694/mja14.01535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/07/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Pele T Bennet
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD
| | | | | | | |
Collapse
|
13
|
Nicholson AK, Borland R, Sterren AE, Bennet PT, Stevens M, Thomas DP. Social acceptability and desirability of smoking in a national sample of Aboriginal and Torres Strait Islander people. Med J Aust 2015; 202:S57-62. [DOI: 10.5694/mja14.01534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Pele T Bennet
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD
| | | | | |
Collapse
|
14
|
Thomas DP, Davey ME, Panaretto KS, Hunt JM, Stevens M, Sterren AE. Smoking among a national sample of Aboriginal and Torres Strait Islander health service staff. Med J Aust 2015; 202:S85-9. [DOI: 10.5694/mja14.01523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/27/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | - Maureen E Davey
- Aboriginal Health Service, Tasmanian Aboriginal Centre, Hobart, TAS
| | | | | | | | | |
Collapse
|
15
|
Gould GS, Watt K, McEwen A, Cadet-James Y, Clough AR. Predictors of intentions to quit smoking in Aboriginal tobacco smokers of reproductive age in regional New South Wales (NSW), Australia: quantitative and qualitative findings of a cross-sectional survey. BMJ Open 2015; 5:e007020. [PMID: 25770232 PMCID: PMC4360823 DOI: 10.1136/bmjopen-2014-007020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the predictors of intentions to quit smoking in a community sample of Aboriginal smokers of reproductive age, in whom smoking prevalence is slow to decline. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey involved 121 Aboriginal smokers, aged 18-45 years from January to May 2014, interviewed at community events on the Mid-North Coast NSW. Qualitative and quantitative data were collected on smoking and quitting attitudes, behaviours and home smoking rules. Perceived efficacy for quitting, and perceived threat from smoking, were uniquely assessed with a validated Risk Behaviour Diagnosis (RBD) Scale. MAIN OUTCOME MEASURES Logistic regression explored the impact of perceived efficacy, perceived threat and consulting previously with a doctor or health professional (HP) on self-reported intentions to quit smoking, controlling for potential confounders, that is, protection responses and fear control responses, home smoking rules, gender and age. Participants' comments regarding smoking and quitting were investigated via inductive analysis, with the assistance of Aboriginal researchers. RESULTS Two-thirds of smokers intended to quit within 3 months. Perceived efficacy (OR=4.8; 95% CI 1.78 to 12.93) and consulting previously with a doctor/HP about quitting (OR=3.82; 95% CI 1.43 to 10.2) were significant predictors of intentions to quit. 'Smoking is not doing harm right now' was inversely associated with quit intentions (OR=0.25; 95% CI 0.08 to 0.8). Among those who reported making a quit attempt, after consulting with a doctor/HP, 40% (22/60) rated the professional support received as low (0-2/10). Qualitative themes were: the negatives of smoking (ie, disgust, regret, dependence and stigma), health effects and awareness, quitting, denial, 'smoking helps me cope' and social aspects of smoking. CONCLUSIONS Perceived efficacy and consulting with a doctor/HP about quitting may be important predictors of intentions to quit smoking in Aboriginal smokers of reproductive age. Professional support was generally perceived to be low; thus, it could be improved for these Aboriginal smokers. Aboriginal participants expressed strong sentiments about smoking and quitting.
Collapse
Affiliation(s)
- Gillian Sandra Gould
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Andy McEwen
- Health Behaviour Research Centre, Epidemiology and Public Health, University College London, London, UK
| | - Yvonne Cadet-James
- Indigenous Centre, James Cook University, Townsville, Queensland, Australia
| | - Alan R Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
16
|
Twyman L, Bonevski B, Paul C, Bryant J. Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open 2014; 4:e006414. [PMID: 25534212 PMCID: PMC4275698 DOI: 10.1136/bmjopen-2014-006414] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth. DESIGN A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. DATA SOURCES MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. STUDY SELECTION Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. DATA EXTRACTION Two authors independently assessed studies for inclusion and extracted data. RESULTS 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). CONCLUSIONS Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. TRIAL REGISTRATION NUMBER A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761).
Collapse
Affiliation(s)
- Laura Twyman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine Paul
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| |
Collapse
|
17
|
Economic rationality in choosing between short-term bad-health choices and longer-term good-health choices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5971-88. [PMID: 24217181 PMCID: PMC3863881 DOI: 10.3390/ijerph10115971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 11/16/2022]
Abstract
Non-contagious, chronic disease has been identified as a global health risk. Poor lifestyle choices, such as smoking, alcohol, drug and solvent abuse, physical inactivity, and unhealthy diet have been identified as important factors affecting the increasing incidence of chronic disease. The following focuses on the circumstance affecting the lifestyle or behavioral choices of Aboriginal and Torres Strait Islander peoples in remote-/very remote Australia. Poor behavioral choices are the result of endogenous characteristics that are influenced by a range of stressful exogenous variables making up the psychosocial determinants including social disenfranchisement, cultural loss, insurmountable tasks, the loss of volitional control and resource constraints. It is shown that poor behavioral choices can be economically rational; especially under highly stressful conditions. Stressful circumstances erode individual capacity to commit to long-term positive health alternatives such as self-investment in education. Policies directed at removing the impediments and providing incentives to behaviors involving better health choices can lead to reductions in smoking and alcohol consumption and improved health outcomes. Multijurisdictional culturally acceptable policies directed at distal variables relating to the psychosocial determinants of health and personal mastery and control can be cost effective. While the content of this paper is focused on the conditions of colonized peoples, it has broader relevance.
Collapse
|
18
|
Dawson AP, Cargo M, Stewart H, Chong A, Daniel M. Identifying multi-level culturally appropriate smoking cessation strategies for Aboriginal health staff: a concept mapping approach. HEALTH EDUCATION RESEARCH 2013; 28:31-45. [PMID: 23221591 DOI: 10.1093/her/cys111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.
Collapse
Affiliation(s)
- Anna P Dawson
- Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | | | | | | | | |
Collapse
|
19
|
Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study. Int J Equity Health 2012; 11:27. [PMID: 22621767 PMCID: PMC3477099 DOI: 10.1186/1475-9276-11-27] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 05/07/2012] [Indexed: 11/11/2022] Open
Abstract
Introduction Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking. Methods We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience in relation to quitting smoking were explored in 34 semi-structured interviews (with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text and interview notes. Results Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting. Conclusions Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community.
Collapse
|