A financial case to enable state health jurisdictions to invest in tobacco control

A Review of Trends in Indigenous Australian Tobacco Research (From 2004 to 2013), its Associated Outputs and Evidence of Research Translation

INTRODUCTION

Smoking prevalence among Indigenous Australians nationally (45%) is more than double that of other Australians but ranges up to 82% in remote communities, causing significant health disparities. This paper examines trends in peer-reviewed research outputs related to Indigenous Australian tobacco control over the past decade and describes their research translation potential and alignment with national and jurisdictional policy priorities.

METHODS

Systematic searches of electronic databases were conducted: Medline, CINAHL, Cochrane Systematic Reviews, PsychInfo, and Australian HealthInfoNET for English-language peer-reviewed publications (2004-2013) primarily focusing on Indigenous Australian tobacco use. Publications were categorized by types, topics, and geographic location. Following established procedures, "reviews" and "commentaries" were distinguished from "original research," the latter further classified as "measurement," "descriptive," or "intervention" studies. Research translation categories used were: "synthesis," "dissemination," "exchange," and "application."

RESULTS

The majority of 78 publications meeting selection criteria focused on cessation treatment (28%), monitoring and prevalence (24%) and passive smoking (13%). "Original research" was mostly "descriptive/epidemiologic" (81%) with few "intervention" studies (9%). Many studies were in remote communities. Components of research translation were identified in 50% of the publications with little evidence of dissemination strategies.

CONCLUSION

Remote community populations are an area of great need. However, generally it is disappointing that since 2004, few intervention studies are available to guide efforts to reduce tobacco-related health disparities. Stronger and more immediate alignment of policy with research that contributes to the evidence-base is required together with more systematic use of research dissemination translation strategies to better match evidence with priorities which may develop rapidly over time.

Environmental attributable fractions in remote Australia: the potential of a new approach for local public health action

OBJECTIVES

To determine local values for environmental attributable fractions and explore their applicability and potential for public health advocacy.

METHODS

Using World Health Organization (WHO) values for environmental attributable fractions, responses from a practitioner survey (73% response rate) were considered by a smaller skills-based panel to determine consensus values for Kimberley environmental attributable fractions (KEAFs). Applied to de-identified data from 17 remote primary healthcare facilities over two years, numbers and proportions of reasons for attendance directly attributable to the environment were calculated for all ages and children aged 0-4 years, including those for Aboriginal patients.

RESULTS

Of 150,357 reasons for attendance for patients of all ages, 31,775 (21.1%) were directly attributable to the environment. The proportion of these directly due to the environment was significantly higher for Aboriginal patients than others (23.1% v 14.6%; p<0.001). Of 29,706 reasons for attendance by Aboriginal children aged 0-4 years, 7,599 (25.6%) were directly attributable to the environment, significantly higher than for non-Aboriginal children aged 0-4 years (25.6% v 18.6%; p<0.001).

CONCLUSIONS

By addressing environmental factors, 20% of total primary healthcare demand could be prevented and, importantly, some 25% of presentations by Aboriginal children.

IMPLICATIONS

KEAFs have potential to monitor impact of local environmental investments.

Trend analysis of hospital admissions attributable to tobacco smoking, Northern Territory Aboriginal and non-Aboriginal populations, 1998 to 2009

BACKGROUND

Tobacco smoking is a well-recognised risk factor for many diseases [1]. This study assesses the extent of smoking-attributable hospitalisation in the Northern Territory (NT) Aboriginal and non-Aboriginal populations, and examines smoking-attributable hospitalisation trends for the years 1998/99 to 2008/09.

METHODS

Hospital discharge data were used for the analysis. The proportion of conditions attributable to tobacco smoking was calculated using the aetiological fraction method. Age-adjusted smoking-attributable hospitalisation rates were calculated to describe the impact of tobacco smoking on the health of Territorians. A negative binominal regression model was applied to examine trends in smoking-attributable hospitalisations.

RESULTS

Aboriginal Territorians were found to have higher rates of smoking-attributable hospitalisation, with Aboriginal males more than three times and Aboriginal females more than four times more likely to be hospitalised for smoking-attributable conditions than their non-Aboriginal counterparts. The age-adjusted hospitalisation rate for Aboriginal males increased by 31% and for Aboriginal females by 18% during the study period. There were more modest increases for NT non-Aboriginal males and females (5% and 17% respectively). The increase among Aboriginal males occurred up until 2005/06 followed by moderation in the trend. There were small reductions in smoking-attributable hospitalisation rates among all populations in younger age groups (less than 25 years).

CONCLUSIONS

Aboriginal Territorians experience much higher smoking-attributable hospitalisation rates than non-Aboriginal Territorians. The scale of the smoking burden and suggestion of recent moderation among Aboriginal men reinforce the importance of tobacco control interventions that are designed to meet the needs of the NT's diverse population groups. Preventing smoking and increasing smoking cessation rates remain priorities for public health interventions in the NT.

Smoking care provision in smoke-free hospitals in Australia

BACKGROUND

The study aimed to (1) determine the current routine smoking care that smoke-free public hospitals in New South Wales (NSW), Australia, provide to inpatients who are smokers; (2) determine current strategies supporting such care; and (3) examine the association between smoking care provision and hospital characteristics and support strategies.

METHOD

A cross-sectional survey of 169 senior hospital managers was undertaken. Survey items included smoking care practices such as identification of smoking status and provision of nicotine replacement therapy as well as hospital activities such as existence of policies and staff training. Hospital characteristics such as size and geographic location were also collected.

RESULTS

Twenty percent of respondents reported provision of minimally 'adequate' smoking care, defined as providing five or more smoking care items to 80% or more of patients. Larger hospitals were significantly less likely to provide adequate smoking care. Nurse training, the existence of signs indicating a smoke-free site and signs indicating location of designated smoking areas were also associated with smoking care provision. The existence of three or more support strategies was associated with smoking care provision.

CONCLUSION

Even in the context of a smoke-free hospital site, the majority of inpatients who are smokers receive inadequate smoking care. Considered investment is required for hospitals to implement strategies to institutionalise the routine provision of appropriate smoking care.

Ageing and healthcare costs in Australia: a case of policy‐based evidence?

There have been dire predictions that population ageing will result in skyrocketing health costs. However, numerous studies have shown that the effect of population ageing on health expenditure is likely to be small and manageable. Pessimism about population ageing is popular in policy debates because it fits with ideological positions that favour growth in the private sector and seek to contain health expenditure in the public sector. It might also distract attention from the need to evaluate the appropriateness and effectiveness of current patterns of care. Pessimistic scenarios have stifled debate and limited the number of policy options considered. Policy making in Australia would be improved if we took a more realistic view of the effect of population ageing on health expenditure.