NAIDOC Week 2020
Raglan Maddox, Katherine A. Thurber, Tom Calma, Glen Benton, Emily Banks, Raymond Lovett
Smoking is a leading contributor to many illnesses and the single biggest contributor to Aboriginal and Torres Strait Islander deaths. An article published in the Australian and New Zealand Journal of Public Health, Deadly news –The downward trend continues in Aboriginal and Torres Strait Islander smoking 2004-2019, used national data to look at changes in Aboriginal and Torres Strait Islander smoking prevalence from 2004/05–2018/19.
The data show:
- The majority (6 out of every 10) of Aboriginal and Torres Strait Islander adults (≥18 years) do not smoke daily.
- Nationally, the percentage of Aboriginal and Torres Strait Islander adults smoking daily is going down.
- It has dropped from 50% in 2004/05 to 40% in 2018/19, a 10% decrease in smoking over the past 15 years.
- Daily smoking went down by 12% for Aboriginal and Torres Strait Islander adults living in urban/regional areas (from 49% to 37%) over the last 15 years.
- There was no change in daily smoking for those living in remote areas (where just over five in ten people smoke daily).
- There are almost 50,000 fewer Aboriginal and Torres Strait Islander adults who smoke daily today compared to if smoking prevalence had remained at 2004/05 levels.
These changes will lead to reduced smoking related illnesses and thousands of premature deaths avoided.
How policy and programs can help to drive change
There is no one-size-fits all approach to reducing tobacco use, but there are approaches that can help. Many Aboriginal and Torres Strait Islander organisations and communities are leading the way. A recent Review of Tobacco use among Aboriginal and Torres Strait Islander peoples by our team at the Australian National University found that effective programs and policies are culturally appropriate and use holistic multipronged approaches. We need a raft of culturally safe, holistic approaches that address the social determinants of tobacco use. These programs need Aboriginal and Torres Strait Islander leadership, and tailoring to meet local needs. This should include a range of evidence-based public health, health promotion and health care approaches at the individual, community and population levels to support smoke free behaviours. Approaches such as brief intervention, pharmacotherapy, media campaigns, education, peer supports, Aboriginal Quitline, smoking free areas, sale restrictions, and programs that address the broader social determinants of tobacco use, for example, the Empowering Strong Families 4077 smoking cessation program (1, 2).
In alignment with the United Nations Declaration on the Rights of Indigenous Peoples, all Aboriginal and Torres Strait Islander peoples must have access to supports to be smoke-free. Ensuring national coverage of tobacco reduction programs and policies, as well as adequate resourcing, will help continue and accelerate these declines in smoking.
Research
We need more evidence about “what works” to reduce smoking among Aboriginal and Torres Strait Islander people, including what works in remote settings. This should be done by developing local, regional and national programs and policies, guided by Aboriginal and Torres Strait Islander peoples; and rigorously evaluating programs, incorporating knowledge from Aboriginal and Torres Strait Islander peoples and service providers. An evaluation of the effectiveness of the Tackling Indigenous Smoking program is underway, and will contribute to this needed evidence. A unique strength of the Tackling Indigenous Smoking program is its ability to be tailored to meet local needs. We need more information on the extent to which the program is contributing to changes in smoking behaviours, overall and for key groups.
Tobacco control remains the “best buy” in improving health. As Wooldridge and Grogan recently outlined, public health must be scientifically informed and supported, in doing what is in the nation’s best interest for public health. We would add that this includes being informed by Aboriginal and Torres Strait Islander peoples. To reduce tobacco use, stable and long-term public health and health promotion programs and policies are required at the national, state, territory and local levels, alongside addressing historical and contemporary colonial factors that produce inequities.
Australia’s history: tobacco and settler-colonialism
We should never forget the legacy of the unique Aboriginal and Torres Strait Islander tobacco history. Tobacco was introduced by colonisers and was used as a way to get Aboriginal and Torres Strait Islander peoples to do labour, adopt European ways of living, convert to Christianity, and share cultural items and knowledge (2). Tobacco was provided to Aboriginal and Torres Strait Islander people as part of rations by government and employers up to the 1960s in some cases. These processes served to entrench tobacco use in the population. Ongoing colonisation is linked to smoking, including through historical and ongoing trauma, stress, racism and exclusion from education and employment. Our history, combined with tobacco industry tactics, and the strong habitual element and the strong chemical dependency properties of nicotine, affects autonomy in decision making around smoking. It is important to recognise these factors and to acknowledge that despite this, large strides have been made by individuals, with families, and across communities, to be smoke-free over the last 15 years.
For more Information
Maddox, R., K. Thurber, T. Calma, E. Banks, and R. Lovett. 2020. Deadly news: the downward trend continues in Aboriginal and Torres Strait Islander smoking 2004–2019. ANZJPH. https://doi.org/10.1111/1753-6405.13049
The Review of Tobacco use among Aboriginal and Torres Strait Islander peoples led by Ms Emily Colonna and Associate Professor Ray Lovett reviewed the evidence on tobacco use among Aboriginal and Torres Strait Islander peoples to provide a comprehensive summary and is accompanied by a summary, a factsheet and a video of the key findings.
For more information and support to quit
For support to help quit, please visit your local AMS, GP or call Aboriginal Quitline on 13 7848.
Sources
- Askew DA, Guy J, Lyall V, Egert S, Rogers L, Pokino L-a, et al. A mixed methods exploratory study tackling smoking during pregnancy in an urban Aboriginal and Torres Strait Islander primary health care service. BMC public health. 2019;19(1):1-10.
- Colonna E, Maddox R, Cohen R, Marmor A, Doery K, Thurber K, et al. Review of tobacco use among Aboriginal and Torres Strait Islander peoples. 2020.
Author details
Raglan Maddox, Modewa Clan, Papua New Guinea, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University. Canberra, Australia
Katherine A. Thurber, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University. Canberra, Australia
Tom Calma, Kungarakan & Iwaidja, National Coordinator, Tackling Indigenous Smoking. Canberra, Australia.
Glen Benton, Wiradjuri, Aboriginal Quitline. Melbourne, Australia.
Emily Banks, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University. Canberra, Australia
Raymond Lovett, Wongaibon (Ngiyampaa) National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University. Canberra, Australia