Targeting tobacco control interventions effectively
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Targeting Tobacco Control Interventions Effectively. Sonny Pilkington Office of Aboriginal Health, Department of Health WA Owen Carter Centre for Behavioural Research in Cancer Control, Curtin University Alex Cameron National Centre for Epidemiology and Population Health, ANU

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Targeting tobacco control interventions effectively

Targeting Tobacco Control Interventions Effectively

Sonny Pilkington Office of Aboriginal Health, Department of Health WA

Owen Carter Centre for Behavioural Research in Cancer Control, Curtin University

Alex Cameron National Centre for Epidemiology and Population Health, ANU

Sandra Thompson Centre for International Health, Curtin University


Targeting tobacco control interventions effectively

100%

General Population

Aboriginal Population

90%

80%

70%

60%

54%

52%

50%

50%

49%

50%

Smoking Prevalence

43%

39%

38%

37%

40%

35%

34%

30%

28%

26%

26%

26%

30%

23%

17%

20%

10%

0%

1965

1970

1975

1980

1985

1990

2000

2005

2010

1945

1950

1955

1960

1995

Year

Australian Smoking Prevalence


Aboriginal deaths per 100 000

271

152

118

56

Aboriginal Deaths per 100,000

Females

Males


Contact list

Contact List

Target

  • AHWs, AHLOs & AHPOs

    Contact Lists

  • Aboriginal Community Controlled Health Services (ACCHS)

  • Department of Health WA

  • Community Health Centres

  • Divisions of General Practice

    Final List

  • N=227

  • First 146 attempted


Sample

Retired, on leave, etc.

Duplicate listing

16

8

Refusals

18

No contact(“out bush”, etc.)

68

36

INTERVIEWED

Sample

N=146

Hit Rate 25%


Sample1

N=146

Retired, on leave, etc.

Duplicate listing

16

8

Sample

N=122

N=54

Hit Rate 25%

Recruitment Rate 30%

Consent Rate 67%

Refusals

18

No contact(“out bush”, etc.)

68

36

INTERVIEWED


Sample2

36

non-smokers

smokers

ex-smokers

Sample

Demographics

  • 100% identified themselves as Aboriginal

  • 8 males and 28 females

  • Average age 41 years (range 20-58 years)

  • Work Status

  • 86% worked in rural areas

  • Worked average 4.5 years (range 1-34 years)

  • Most common education– Certificate in Aboriginal Health

  • – range: nothing to post-graduate

    • Smoking Status

    • Smokers n=11 (31%)

    • Ex-smokers n=11 (31%)

    • Non-smokers n=14 (38%)


Which of the following is the biggest health issue for aboriginal people

4th

2nd

1st

5th

3rd

100%

100%

100%

100%

100%

98%

97%

86%

80%

81%

67%

67%

61%

58%

45%

36%

28%

27%

22%

20%

11%

8%

3%

0%

Diabetes

Alcohol

HeartDisease

STIs

Smoking

Health Priorities

“Which of the following is the biggest health issue for Aboriginal people?”


Do you think smoking is a serious problem within the aboriginal community

“Do you think smoking is a serious problem within the Aboriginal community?”

Not serious

19%

Serious

34%

47%

Very serious


What proportion of your clients do you ask if they smoke

18%

33%

36%

71%

17%

10%

33%

36%

29%

17%

“What proportion of your clients do you ask if they smoke?”

Non-smokers

Ex-smokers

Smokers

(n=14)

(n=11)

(n=11)

All (100%)

Most (50-99%)

Minority (1–49%)

None (0%)


What kinds of things stop you from advising more people to stop smoking

“What kinds of things stop you fromadvising more people to stop smoking?”

“My job’s STIs”

“My job’s immunisation”

“there’s no support from work colleagues because they all smoke…it’s hard to tell others not to”

“Be aware of who you are speaking to...”

“they would tell you ‘where to go’ —it’s up to them—they know the dangers”

“depends on if they want to or not”

“I’m a smoker; if I can’t [quit] how can I tell anyone [to] of their own free will?”

“they would tell me ‘where to go’ because my husband’s a smoker”


What sorts of things do you do to help clients quit smoking

“What sorts of things do you doto help clients quit smoking?”

“I tell them it causes heart disease”

“I yarn with them and give information”

“tell them if going bush don’t take any [cigarettes] with you—the craving will be less when you come back”

“go hunting”

“eat lollies and fruit”


What training have you had to help people quit smoking

brief intervention course

19%

part of

qualifications

8%

NONE

informal training

62%

11%

“What training have you had to help people quit smoking?”


Would you like more training to help people quit

NO

29%

71%

YES

“Would you like more training to help people quit?”

“it was a comprehensive course”

“have you ever heard of the term ‘overtrained’ ?”

“don’t have time but might be interesting”

“it’s not an interest of mine”

“it’s their choice–there’s enough information out there”


Health effects of smoking

50%

20%

14%

Smokers

Ex-smokers

Non-smokers

Health Effects of Smoking


Health effects of passive smoking

30%

40%

20%

14%

10%

0%

Smokers

Ex-smokers

Non-smokers

Smokers

Ex-smokers

Non-smokers

Health Effects of Passive Smoking


Nicotine dependence

Nicotine Dependence


Nicotine withdrawal symptoms

Nicotine Withdrawal Symptoms


Existing quitting aids

Existing Quitting Aids


Summary

Summary

  • Tobacco is a chronic but invisible health problem

  • Barriers to giving cessation advice:

    • Being a smoker and fear of hypocrisy (quit)

    • Cultural respect (motivational interviewing)

    • Demarcation (brief intervention)

  • Good knowledge about harmful effects of smoking

  • Knowledge suboptimal of:

    • the principles of brief intervention

    • nicotine dependence and appropriate treatment

  • Nearly two-thirds have no smoking cessation training

  • Around three-quarters want training

  • Baseline measurement can track improvements into the future


Targeting tobacco control interventions effectively

Sage Tiberius Carter(2 years)

Ariel Rhiannon Carter(4 years)


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