Thousands of premature deaths have been prevented by the drop in tobacco use among Aboriginal Torres Strait Islander people, write Ms Emily Colonna, Dr Raglan Maddox, Dr Katherine Thurber, and Associate Professor Ray Lovett of the Australian National University. Acknowledging the contribution of factors such as colonisation to smoking rates will help to accelerate this trend.
Emily Colonna, Raglan Maddox, Katherine Thurber, and Ray Lovett write:
Smoking prevalence within the Aboriginal and Torres Strait Islander population has declined by almost 10 percentage points in the past 15 years, and accelerating further reductions is possible.
Smoking is the leading contributor to the burden of disease among Aboriginal and Torres Strait Islander peoples; it contributes to many health issues such as heart and lung diseases, diabetes, and various forms of cancer.
The huge impact of smoking to health at the population level means that there is massive potential for health gain by reducing smoking. Tobacco control presents a clear way forward for major improvement in Aboriginal and Torres Strait Islander health.
Daily smoking prevalence for adults in 2018-19 was 40.2 percent, a drop from 50.0 percent in 2004-05. The drop in smoking was largest among younger adults and people living in urban and regional areas, where most Aboriginal and Torres Strait Islander peoples live. Accelerating smoking reductions is achievable with appropriate resources and supports.
Associate Professor Ray Lovett says the drop in smoking will prevent tens of thousands of premature deaths, compared to if smoking prevalence had remained at the previous level.
Never smoking at all, or quitting smoking, is important. Quitting smoking at any age can help reverse the health risks linked to smoking. Almost all smokers want to quit, and many are working towards this.
The Talking about the Smokes Study found that 69 percent of people who smoke daily had previously made a quit attempt, and 48 percent had made a quit attempt in the past year. This tells us that there continues to be opportunities to accelerate reductions in tobacco use, with enthusiasm to improve community health and wellbeing outcomes.
Colonisation and contextual factors
Starting smoking, continuing to smoke, and stopping smoking are all complex behaviours, influenced by a range of factors.
Colonisation is an important factor contributing to smoking. Tobacco was introduced by colonisers and tobacco was used as a way to get Aboriginal and Torres Strait Islander people to do labour, adopt European ways of living, convert to Christianity, and exchange cultural items and knowledge.
Tobacco was also a part of rations provided by government or employers, which continued until the 1960s in some cases.
Colonisation is also implicated in other tobacco-related factors: colonisation has led to ongoing trauma, stress, racism, and exclusion from education and employment, which are all linked to smoking.
The entrenchment of smoking through colonisation and its ongoing impacts, and through tobacco industry tactics, has taken away Aboriginal and Torres Strait Islander peoples’ autonomy to choose to smoke or not.
It is important to recognise these influences and empower Aboriginal and Torres Strait Islander peoples to make the choice to be smoke-free.
Additional factors linked to tobacco use include: exposure to tobacco industry marketing, knowledge about the health impacts of tobacco use, social and emotional wellbeing, and other substance use.
The normalisation of smoking and the social role smoking and sharing tobacco plays influence smoking. Public health messaging and changes in social norms are denormalising smoking and encouraging smoke free lives. The support of family, friends and communities helps people to quit, and stay quit.
Policy and program implications
There is no silver bullet to reducing tobacco use.
We need a suite of culturally safe, holistic approaches that address the social determinants of tobacco use. This should include a range of health care options and education at the individual and community level to support Aboriginal and Torres Strait Islander peoples to be smoke free.
Community, health services and governments are running various programs and policies to support people to quit smoking, to never start smoking, and to reduce exposure to second-hand smoke.
The review found that effective programs are culturally appropriate and use holistic multi-pronged approaches.
A holistic approach includes addressing the broader social, cultural and environmental determinants of health and wellbeing.
To be culturally appropriate, programs should be developed by, or with, Aboriginal and Torres Strait Islander communities; prioritise Aboriginal and Torres Strait Islander voices and leadership; build long-term, trusting relationships; and enable flexible program delivery, to adapt to community needs.
Programs that are likely be the most successful in reducing tobacco use are those that provide multiple supports to be smoke free at the individual, community and legislative level.
Approaches have included aspects such as brief interventions, pharmacotherapies, media campaigns, education, peer supports, Quitline, smoking bans, sale restrictions, as well as programs and initiatives that address the broader social determinants of tobacco use.
Accelerating the progress
All Aboriginal and Torres Strait Islander peoples deserve access to supports to be smoke-free. Ensuring national coverage of tobacco reduction programs and policies, as well as adequate resourcing, will help this deadly progress continue.
We need more evidence about “what works” to tackle smoking. This should be done by: developing local, regional and national programs and policies, guided by Aboriginal and Torres Strait Islander peoples; rigorously evaluating programs, incorporating knowledge from Aboriginal and Torres Strait Islander peoples and service providers; and expanded and long-term funding to ensure all Aboriginal and Torres Strait Islander peoples have access to effective and appropriate tobacco control programs and initiatives.
The Review of Tobacco use among Aboriginal and Torres Strait Islander peoples led by Ms Emily Colonna and Associate Professor Ray Lovett of the Aboriginal and Torres Strait Islander Health Program reviewed the evidence on tobacco use among Aboriginal and Torres Strait Islander peoples to provide a comprehensive summary.
The peer-reviewed paper was published by The Alcohol and Other Drugs Knowledge Centre at The Australian Indigenous HealthInfoNet and is accompanied by a plain language summary, a factsheet of key findings and a video of the key findings.
Ms Emily Colonna is Research Officer; Dr Raglan Maddox is a Research Fellow and is leading the evaluation of the Tackling Indigenous Smoking (TIS) program; Dr Katherine Thurber is a Research Fellow; and Associate Professor Ray Lovett is Program Leader, at the Aboriginal and Torres Strait Islander Health Program, The Australian National University.