Informing a national approach to Aboriginal tobacco control

Project title: A comprehensive approach to Aboriginal and Torres Strait Islander tobacco control

Start date: January 2015
Estimated end date: December 2017

What is the issue?

Tobacco use remains high among Aboriginal adults despite a decline in recent years, from 49% in 2002 to 41% in 2012. Tobacco use is also high in young Aboriginal and Torres Strait people, with 39% of those aged 15-24 years smoking daily. In contrast, among the total population, Australia has one of the lowest rates of smoking in the world, with 16% of adults reported to smoke.

Smoking is the major preventable risk factor contributing to the gap in life expectancy between Aboriginal and Torres Strait Islander people and other Australians.

Efforts to reduce tobacco use among Aboriginal people have varied between States. Recent Commonwealth policies have focused on Aboriginal tobacco action workers as well as regional tobacco coordinators, enhanced quit line services and social marketing campaigns.

Currently, in Australia there is no national framework to guide action on reducing tobacco use among Aboriginal people or recent research about smoking uptake among Aboriginal adolescents.

While smoking is related to the persistent disadvantage that Aboriginal people face, there is a need for a concerted systematic approach to reduce smoking among Aboriginal people.

How is the project addressing the issue?

The project will have four major components:

1. Modify an evidence-based guide on tobacco control to help Australian States establish comprehensive tobacco control programs for Aboriginal Australians. The project will identify settings and subgroups where tobacco control initiatives may be particularly effective for Aboriginal people (eg, smoke-free prison policies, reducing adolescent smoking uptake, incentives to reduce smoking during pregnancy). This approach is aimed at a systematic and coordinated effort to guide Indigenous tobacco control initiatives.
2. Review what is known about what works to reduce tobacco consumption in Aboriginal people with a focus on effective settings and subgroups. The project will conduct a high-level review, drawing together existing reviews, any new studies and possibly the grey literature.
3. Audit current tobacco-reduction programs targeting Indigenous Australians in 2-4 States and compare existing programs with potentially effective settings and subgroups and evidence of benefit. This would create a whole-of-state map including programs being delivered by Aboriginal Community Controlled Health Services, non-government organisations and government. The project will look at how these programs are working in practice and the reasons for their design, using methods for synthesising practitioner knowledge that the Prevention Centre is developing. This component will assess the extent to which best practice is delivered and opportunities to improve program delivery.
4. Explore the determinants of smoking uptake and develop interventions focused on reducing smoking uptake among Aboriginal adolescents. This will address a key driver of Aboriginal smoking rates and an important gap in current knowledge and practice.

The work will involve:

• A systematic review of the literature to establish rates of smoking among young Aboriginal people in Australia and globally and the determinants of smoking in this vulnerable group
• Qualitative studies with Aboriginal adolescents to explore their knowledge and attitudes about smoking and factors in successful interventions to curb smoking uptake
• Developing an intervention targeting smoking uptake among Aboriginal adolescents.

Relevance for practice

Drawing on existing evidence, the project will look at current programs and assess best practice and opportunities for improvement. It will provide policy makers with a framework for a systematic approach to reducing tobacco use among Aboriginal people, particularly focusing on smoking in young Aboriginal people.

What are the expected outcomes?

The project will establish parameters for a more comprehensive and systematic approach to reducing smoking by Indigenous Australians and compare this with current practice.