Predictors and reasons for quitting smoking in remote Aboriginal and Torres Strait Islander communities

ISSUE ADDRESSED

National smoking prevalence is decreasing among Aboriginal and Torres Strait Islander people. In remote areas, Aboriginal and Torres Strait Islander smoking prevalence remains higher than in nonremote areas and is not improving.

METHODS

We analysed data from 539 daily and weekly smokers from remote areas who completed baseline surveys at either Wave 1 (April 2012-October 2013) or Wave 2 (August 2013-August 2014), including 157 from Wave 1 who also completed Wave 2, from the Talking About The Smokes project. We assessed associations between baseline predictor measures and having made any quit attempt in the past year and, among those who did, having sustained the last quit attempt for one month or more.

RESULTS

More smokers had made a quit attempt if they were younger or reported being unable to buy essentials due to money spent on smokes, being more stressed, having several pro-quitting motivations and attitudes, having an effective smoke-free home, or being encouraged to quit by a health professional or by family/friends. Of these, more had sustained their last quit attempt for one month or more if they reported being more socially advantaged, no smoking-induced deprivation, being less dependent, chewing pituri or an having effective smoke-free home.

CONCLUSIONS

Health staff should consider the quite different factors associated with starting and then sustaining a quit attempt. SO WHAT?: Our findings support continued attention in remote areas on smoke-free homes and health staff providing regular encouragement to all smokers to quit and more use of smokers' friends and family for support.

Acceptance of smoking cessation support and quitting behaviours of women attending Aboriginal Maternal and Infant Health Services for antenatal care

BACKGROUND

Acceptance of smoking cessation support during antenatal care and associated quitting behaviours of pregnant Aboriginal women or women having an Aboriginal baby has not been investigated. This study aimed to determine, among pregnant women who smoke and attended AMIHS for their antenatal care: 1. The acceptance of smoking cessation support, factors associated with acceptance and barriers to acceptance; 2. The prevalence of quitting behaviours and factors associated with quitting behaviours.

METHODS

A cross-sectional telephone survey of women who attended 11 AMIHSs for their antenatal care during a 12 month period in the Hunter New England Local Health District of New South Wales.

RESULTS

One hundred women contacted consented to complete the survey (76%). Of those offered cessation support, 68% accepted NRT, 56% accepted follow-up support and 35% accepted a Quitline referral. Participants accepting NRT had greater odds of quitting smoking at least twice during the antenatal period [OR = 6.90 (CI: 1.59-29.7)] and those reporting using NRT for greater than eight weeks had six times the odds of quitting smoking for one day or more [OR = 6.07 (CI: 1.14-32.4)].

CONCLUSIONS

Aboriginal women or women having an Aboriginal baby who smoke make multiple attempts to quit during pregnancy and most women accept smoking cessation support when offered by their antenatal care providers. Acceptance of care and quitting success may be improved with increased focus on culturally appropriate care and enhanced training of antenatal care providers to increase skills in treating nicotine addiction and supporting women to use NRT as recommended by treatment guidelines.

Recruiting a representative sample of urban South Australian Aboriginal adults for a survey on alcohol consumption

BACKGROUND

Population estimates of alcohol consumption vary widely among samples of Aboriginal and Torres Strait Islander (Indigenous) Australians. Some of this difference may relate to non-representative sampling. In some communities, household surveys are not appropriate and phone surveys not feasible. Here we describe activities undertaken to implement a representative sampling strategy in an urban Aboriginal setting. We also assess our likely success.

METHODS

We used a quota-based convenience sample, stratified by age, gender and socioeconomic status to recruit Indigenous Australian adults (aged 16+) in an urban location in South Australia. Between July and October 2019, trained research staff (n = 7/10, Aboriginal) recruited community members to complete a tablet computer-based survey on drinking. Recruitment occurred from local services, community events and public spaces. The sampling frame and recruitment approach were documented, including contacts between research staff and services, and then analysed. To assess representativeness of the sample, demographic features were compared to the 2016 Australian Bureau of Statistics Census of Population and Housing.

RESULTS

Thirty-two services assisted with data collection. Many contacts (1217) were made by the research team to recruit organisations to the study (emails: n = 610; phone calls: n = 539; texts n = 33; meetings: n = 34, and one Facebook message). Surveys were completed by 706 individuals - equating to more than one third of the local population (37.9%). Of these, half were women (52.5%), and the average age was 37.8 years. Sample characteristics were comparable with the 2016 Census in relation to gender, age, weekly individual income, Indigenous language spoken at home and educational attainment.

CONCLUSION

Elements key to recruitment included: 1) stratified sampling with multi-site, service-based recruitment, as well as data collection events in public spaces; 2) local services' involvement in developing and refining the sampling strategy; and 3) expertise and local relationships of local Aboriginal research assistants, including health professionals from the local Aboriginal health and drug and alcohol services. This strategy was able to reach a range of individuals, including those usually excluded from alcohol surveys (i.e. with no fixed address). Carefully pre-planned stratified convenience sampling organised in collaboration with local Aboriginal health staff was central to the approach taken.

Who responds? An examination of response rates to a national postal survey of Aboriginal and Torres Strait Islander adults, 2018-2019

Background

Evidence on the effectiveness of postal recruitment methods for Indigenous peoples is lacking. Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, uses multi-staged sampling. We aimed to test postal surveys as a primary recruitment method, analysing preliminary response rate data to inform the Study’s ongoing sampling approach.

Methods

Twenty thousand adults aged ≥16 years were sampled from Aboriginal and Torres Strait Islander people enrolled in the Medicare Australia Enrolment Database. We calculated response rates at 4 and 15 weeks, overall and by age group, gender, state/territory and remoteness.

Results

The overall response rate was 2.3% (n = 456/20000). Highest response rates were observed among males and females ≥50 years from major cities (6.0, 95%CI 4.4–7.9 and 5.5%, 4.1–7.2, respectively) and regional areas (6.0%, 4.6–7.6 and 6.2%, 4.9–7.7, respectively). Younger age groups and remote areas had lower response rates; all remote age groups < 50 years had a response rate ≤ 0.6%. While most participants responded on the paper surveys, online responses were more common among younger age groups and, respondents with higher education levels and whose first language was not English.

Conclusion

Using a postal survey, we observed response rates of ≥5.5% among older Aboriginal and Torres Strait Islander adults in major cities and regional areas; response rates were lower in other groups. A two-stage postal distribution approach provided an opportunity to adapt sampling approaches to different demographic groups. Based on initial response rates, the sampling strategy was revised to send postal surveys to groups with higher response rates groups and focus field recruitment strategies on low response groups.

What does it mean to conduct participatory research with Indigenous peoples? A lexical review

BACKGROUND

To better understand and promote public health, participatory research with Indigenous peoples represents recommended practice, worldwide. However, due to the different ways such research is referred to, described, and used, it is unclear what might (and might not) warrant the term when collaborating with Indigenous peoples. As such, this article expands conceptual understandings of participatory research with Indigenous peoples, across timelines and regions.

METHOD

Following a systematic search of 29 academic databases in April 2018, a lexical analysis of the methods sections was conducted, which were sourced from 161 publications across 107 journals.

RESULTS

The active involvement of Indigenous peoples in research that is expressly participatory is limited across all project phases. This might be because the ways in which Indigenous peoples were involved throughout were not reported - however, it might also be because Indigenous peoples were not involved in all project phases. Furthermore, descriptions differ by study location and publication timeframe - notably, studies in the region of the Americas chiefly refer to pandemics, surveyors, and art; and those published in the last two decades have given primacy to artifacts of interest.

CONCLUSIONS

Findings from this corpus of data suggest participatory research with Indigenous peoples is not always described across different project phases; furthermore, it differs according to study location and publication timeframe. This offers considerable opportunity to further this important research area via alternative methodologies that award primacy to Indigenous expertise and agency.

Electronic Cigarette Use and Understanding Among a National Sample of Australian Aboriginal and Torres Strait Islander Smokers

Introduction

Adult daily smoking prevalence in the Aboriginal and Torres Strait Islander population is 2.8 times that of other Australians. There is little data on prevalence of electronic cigarette (e-cigarette) use among Aboriginal and Torres Strait Islander peoples. We measured e-cigarette use and beliefs about their harmfulness in national samples of Aboriginal and Torres Strait Islander smokers and of all Australian smokers.

Methods

The Talking About the Smokes project interviewed a nationally representative quota sample of 1301 Aboriginal and Torres Strait Islander smokers between August 2013 and August 2014. The Australian Wave 9 survey of the long-running International Tobacco Control Project interviewed 1093 smokers between February and May 2013. Estimates for all Australian smokers were standardized to the age and sex distribution of Aboriginal and Torres Strait Islander smokers.

Results

Fewer Aboriginal and Torres Strait Islander than all Australian smokers had tried an e-cigarette (21% vs. 30%). This was in part because of more Aboriginal and Torres Strait Islander smokers having not heard of e-cigarettes. Fewer Aboriginal and Torres Strait Islander smokers than all Australian smokers agreed that e-cigarettes are less harmful than conventional cigarettes (22% vs. 50%).

Conclusions

Many Aboriginal and Torres Strait Islander smokers have used e-cigarettes. However, there is considerable misunderstanding about the relative harm of e-cigarettes compared with conventional cigarettes, in part because of the tight regulatory environment in Australia.

Implications

The study describes e-cigarette use and understanding in national samples of Aboriginal and Torres Strait Islander smokers and of all Australian smokers. Only small studies have reported on e-cigarette use in this high smoking prevalence population. Fewer Aboriginal and Torres Strait Islander smokers than all Australian smokers had tried an e-cigarette and fewer agreed that e-cigarettes are less harmful than conventional cigarettes. Australian governments, health authorities, health professionals, and e-cigarette regulations should provide clearer messages that e-cigarettes are less harmful.

Enhancing national data to align with policy objectives: Aboriginal and Torres Strait Islander smoking prevalence at finer geographic levels

Objectives The aim of the study was to assess the utility of national Aboriginal survey data in a regional geospatial analysis of daily smoking prevalence for Aboriginal and Torres Strait Islander Australians and discuss the appropriateness of this analysis for policy and program impact assessment. Methods Data from the last two Australian Bureau of Statistics (ABS) national surveys of Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Social Survey 2014-15 (n=7022 adults) and the National Aboriginal and Torres Strait Islander Health Survey 2012-13 (n=10896 adults), were used to map the prevalence of smoking by Indigenous regions. Results Daily smoking prevalence in 2014-15 at Indigenous regions ranges from 27.1% (95%CI 18.9-35.3) in the Toowoomba region in Queensland to 68.0% (95%CI 58.1-77.9) in the Katherine region in the Northern Territory. The confidence intervals are wide and there is no significant difference in daily smoking prevalence between the two time periods for any region. Conclusion There are significant limitations with analysing national survey data at finer geographical scales. Given the national program for Indigenous tobacco control is a regional model, evaluation requires finer geographical analysis of smoking prevalence to inform public health progress, policy and program effects. Options to improve the data currently collected include increasing national survey sample sizes, implementing a smoking status question in census surveys, investing in current cohort studies focused on this population or implementing localised surveys. What is known about the topic? The last geospatial analysis of Aboriginal and Torres Strait Islander smoking prevalence was undertaken in 1997. Current national survey data have not been analysed geospatially. What does this paper add? This paper provides new insights into the use of national survey data for understanding regional patterns and prevalence levels of smoking in Aboriginal and Torres Strait Islander populations. What are the implications for practitioners? The findings of the study suggest caution when interpreting prevalence maps and highlight the need for greater sample sizes in national survey data. The analysis is also an opportunity to assess the use of national survey data in evaluating the policy impact of programs targeted at a regional level.