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Leinberger-Jabari A, Golob MM, Lindson N, Hartmann-Boyce J. Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses. Addiction 2024; 119:629-648. [PMID: 38105395 DOI: 10.1111/add.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. METHOD We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community-based, primary care or web-based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3 months following baseline. We examined comparisons between either an intensity-matched culturally tailored intervention and a non-tailored intervention or a standard non-tailored intervention and the same intervention plus a culturally tailored adjunct. We sub-grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. RESULTS We identified 43 studies, 33 of which were meta-analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity-matched culturally tailored cessation interventions increased quit success when compared with non-tailored interventions at 3-month follow-up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. CONCLUSION Culturally tailored smoking cessation interventions may help more people to quit smoking than a non-tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms.
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Affiliation(s)
- Andrea Leinberger-Jabari
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Melanie M Golob
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Nicola Lindson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
- Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, United States
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Trigg J, Skelton E, Lum A, Guillaumier A, McCarter K, Handley T, Judd L, Lye A, Bonevski B. Smoking Cessation Interventions and Abstinence Outcomes for People Living in Rural, Regional, and Remote Areas of Three High-Income Countries: A Systematic Review. Nicotine Tob Res 2023; 25:1709-1718. [PMID: 37338988 PMCID: PMC10475608 DOI: 10.1093/ntr/ntad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/10/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence. AIMS AND METHODS Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings. RESULTS Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy. CONCLUSIONS Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered. IMPLICATIONS Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence.
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Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alistair Lum
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Ashleigh Guillaumier
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kristen McCarter
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Tonelle Handley
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Lucy Judd
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alexie Lye
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Cameron E, Bryant J, Cashmore A, Passmore E, Oldmeadow C, Neill S, Milat A, Mitchell J, Gatt N, Macoun E, Ioannides SJ, Murray C. A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby. BMC Health Serv Res 2023; 23:532. [PMID: 37226175 DOI: 10.1186/s12913-023-09496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Quit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative. METHODS A mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact. RESULTS QFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96-1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients. CONCLUSION QFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.
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Affiliation(s)
- Emilie Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Aaron Cashmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Erin Passmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information and Statistical Support, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Sarah Neill
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Andrew Milat
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Jo Mitchell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Nicole Gatt
- Drug Health Services, Aboriginal Health Education Officer, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Edwina Macoun
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Sally J Ioannides
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Carolyn Murray
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
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McGuffog R, Bryant J, Booth K, Collis F, Brown A, Hughes JT, Chamberlain C, McGhie A, Hobden B, Kennedy M. Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3993. [PMID: 36901001 PMCID: PMC10001772 DOI: 10.3390/ijerph20053993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Romany McGuffog
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kade Booth
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Felicity Collis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex Brown
- Indigenous Genomics, Australia National University, Canberra, ACT 2601, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jaquelyne T. Hughes
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT 0810, Australia
| | - Catherine Chamberlain
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Alexandra McGhie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Breanne Hobden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
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Heris C, Lovett R, Barrett EM, Calma T, Wright A, Maddox R. Deadly declines and diversity - understanding the variations in regional Aboriginal and Torres Strait Islander smoking prevalence. Aust N Z J Public Health 2022; 46:558-561. [PMID: 35924895 DOI: 10.1111/1753-6405.13286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christina Heris
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory.,Ngiyampaa (Wongaibon), Australia
| | - Eden M Barrett
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory
| | - Tom Calma
- Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group.,Office of the National Coordinator, Tackling Indigenous Smoking, Canberra, Australian Capital Territory.,Poche Indigenous Health Network, Sydney, New South Wales.,Ninti One, Adelaide, South Australia
| | - Alyson Wright
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory
| | - Raglan Maddox
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory.,Bagumani (Modewa) Clan, Papua New Guinea
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6
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The effectiveness of smoking cessation interventions in rural and remote populations: Systematic review and meta-analyses. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103775. [PMID: 35772266 DOI: 10.1016/j.drugpo.2022.103775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rural and remote residents are more likely to smoke tobacco than those in major cities. However, they may experience unique systemic, provider, and individual barriers to accessing smoking cessation treatments, including distance and limited resources. Understanding the effectiveness of smoking cessation interventions in this population is important due to higher smoking-related disease burden and death compared to those in major cities. METHODS Medline, EMBASE, Scopus, PsychINFO, and Cochrane Library were searched until 19-02/2021. Inclusion criteria were randomised controlled trials (RCTs), cluster RCTs, randomised trials, or cluster randomised trials investigating behavioural interventions and pharmacotherapies for smoking cessation in rural and remote populations compared with a control or another smoking cessation treatment; and published in English. Given there is no internationally-standardised rurality index, definitions of 'rural' and 'remote' used by authors of studies were applied to reflect their country. Exclusion criteria were studies of non-combustible smoking cessation; and studies with urban participants in the sample. Two reviewers independently screened records for eligibility, extracted data from studies utilising a modified Cochrane Effective Practice and Organisation of Care Group form, and rated methodological quality using the Quality Assessment Tool for Quantitative Studies. RESULTS Sixteen studies were included. Meta-analysis revealed a statistically significant treatment effect of individual face-to-face counselling on smoking cessation (RR 2.35, 95% CI 1.16-4.76, I2=0%) in rural and remote populations. There was no statistically significant treatment effect for nicotine replacement therapy (RR 2.97, 95% CI 0.84-10.53, I2=47%), telephone-counselling (RR 1.69, 95% CI 0.56-5.06, I2=62%), and community-based multiple-interventions (RR:1.57, 95% CI 0.89-2.78, I2=85%). Certainty of evidence was rated very low for each meta-analysis. CONCLUSION Despite limited resources in rural and remote settings, individual face-to-face counselling for smoking cessation appears promising. Given the limited number of studies, further research about the effectiveness of smoking cessation interventions in rural and remote populations is warranted.
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Krakouer J, Savaglio M, Taylor K, Skouteris H. Community-based models of alcohol and other drug support for First Nations peoples in Australia: A systematic review. Drug Alcohol Rev 2022; 41:1418-1427. [PMID: 35546281 PMCID: PMC9542511 DOI: 10.1111/dar.13477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022]
Abstract
Issues The transgenerational impacts of colonisation—inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation—places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community‐based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community‐based models of AOD support for First Nations adults in Australia. Approach A systematic search of the empirical literature from the past 20 years was conducted. Key Findings Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap‐around psychosocial support, increased local community participation and engagement, funding and breaking down silos. Implications Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community‐based AOD services for First Nations peoples. Conclusion There is a limited evidence‐base for community‐based AOD programs for First Nations peoples. First Nations‐led research that is controlled by and co‐produced with First Nations peoples is necessary to extend our understanding of community‐based programs within First Nations communities.
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Affiliation(s)
- Jacynta Krakouer
- Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melissa Savaglio
- Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karinda Taylor
- First Peoples' Health and Wellbeing, Thomastown and Frankston, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public and Preventive Medicine, Monash University, Melbourne, Australia.,Warwick Business School, University of Warwick, Conventry, UK
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Rahman T, Baker AL, Gould GS, Palazzi K, Lambkin D, Kennedy M. Factors Associated with Smoke-Free Pregnancy among Aboriginal and Torres Strait Women and Their Experience of Quitting Smoking in Pregnancy: A Mixed Method Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11240. [PMID: 34769756 PMCID: PMC8583423 DOI: 10.3390/ijerph182111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Smoke-free pregnancies have long-term health benefits for mothers and babies. This paper quantitatively examines factors associated with smoke-free pregnancies among Aboriginal and Torres Strait Islander women (hereafter Aboriginal women) and qualitatively explores their smoking cessation (SC) experiences during pregnancy. An Aboriginal-led online cross-sectional study on SC was conducted with Aboriginal women and in partnership with Aboriginal communities, between July and October 2020. The present analysis includes participants who made a pregnancy-related quit attempt (N = 103). Chi-squared tests, logistic regression models, and thematic analysis of free-form text responses were performed. The adjusted odds of having smoke-free pregnancies were 4.54 times higher among participants who used Aboriginal Health Services (AHS) (AOR = 4.54, p-value 0.018). Participants living in urban settings had 67% lower odds of having smoke-free pregnancies compared to their regional/remote counterparts (AOR = 0.33, p-value 0.020). Qualitative data revealed strong motivations to reduce tobacco-related harms to the fetus and variability in quitting experiences at different stages of and across pregnancies. Smoking cessation care (SCC) can support Aboriginal women meaningfully if their quitting experiences are considered in SCC development and implementation. Consistent funding for AHS-led SCC is needed to garner health benefits for Aboriginal peoples. More research into urban versus regional/remote differences in maternal SC is recommended.
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Affiliation(s)
- Tabassum Rahman
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Amanda L. Baker
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - David Lambkin
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
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9
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Lindson N, Pritchard G, Hong B, Fanshawe TR, Pipe A, Papadakis S. Strategies to improve smoking cessation rates in primary care. Cochrane Database Syst Rev 2021; 9:CD011556. [PMID: 34693994 PMCID: PMC8543670 DOI: 10.1002/14651858.cd011556.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary care is an important setting in which to treat tobacco addiction. However, the rates at which providers address smoking cessation and the success of that support vary. Strategies can be implemented to improve and increase the delivery of smoking cessation support (e.g. through provider training), and to increase the amount and breadth of support given to people who smoke (e.g. through additional counseling or tailored printed materials). OBJECTIVES To assess the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings. To assess whether any effect that these interventions have on smoking cessation may be due to increased implementation by healthcare providers. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and trial registries to 10 September 2020. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs (cRCTs) carried out in primary care, including non-pregnant adults. Studies investigated a strategy or strategies to improve the implementation or success of smoking cessation treatment in primary care. These strategies could include interventions designed to increase or enhance the quality of existing support, or smoking cessation interventions offered in addition to standard care (adjunctive interventions). Intervention strategies had to be tested in addition to and in comparison with standard care, or in addition to other active intervention strategies if the effect of an individual strategy could be isolated. Standard care typically incorporates physician-delivered brief behavioral support, and an offer of smoking cessation medication, but differs across studies. Studies had to measure smoking abstinence at six months' follow-up or longer. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our primary outcome - smoking abstinence - was measured using the most rigorous intention-to-treat definition available. We also extracted outcome data for quit attempts, and the following markers of healthcare provider performance: asking about smoking status; advising on cessation; assessment of participant readiness to quit; assisting with cessation; arranging follow-up for smoking participants. Where more than one study investigated the same strategy or set of strategies, and measured the same outcome, we conducted meta-analyses using Mantel-Haenszel random-effects methods to generate pooled risk ratios (RRs) and 95% confidence intervals (CIs). MAIN RESULTS We included 81 RCTs and cRCTs, involving 112,159 participants. Fourteen were rated at low risk of bias, 44 at high risk, and the remainder at unclear risk. We identified moderate-certainty evidence, limited by inconsistency, that the provision of adjunctive counseling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost-free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. There was also moderate-certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow-up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants). There was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies we judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty. We downgraded the evidence due to imprecision, inconsistency and risk of bias across these comparisons. There was some indication that provider training increased the delivery of smoking cessation support, along with the provision of adjunctive counseling and cost-free medications. However, our secondary outcomes were not measured consistently, and in many cases analyses were subject to substantial statistical heterogeneity, imprecision, or both, making it difficult to draw conclusions. Thirty-four studies investigated multicomponent interventions to improve smoking cessation rates. There was substantial variation in the combinations of strategies tested, and the resulting individual study effect estimates, precluding meta-analyses in most cases. Meta-analyses provided some evidence that adjunctive counseling combined with either cost-free medications or provider training enhanced quit rates when compared with standard care alone. However, analyses were limited by small numbers of events, high statistical heterogeneity, and studies at high risk of bias. Analyses looking at the effects of combining provider training with flow sheets to aid physician decision-making, and with outreach facilitation, found no clear evidence that these combinations increased quit rates; however, analyses were limited by imprecision, and there was some indication that these approaches did improve some forms of provider implementation. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that providing adjunctive counseling by an allied health professional, cost-free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. There is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, we rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. Further studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting. Such studies should be cluster-randomized to account for the implications of implementation in this particular setting. Due to substantial variation between studies in this review, identifying optimal characteristics of multicomponent interventions to improve the delivery of smoking cessation treatment was challenging. Future research could use component network meta-analysis to investigate this further.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gillian Pritchard
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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Thomas DP, Panaretto KS. Predictors and reasons for quitting smoking in remote Aboriginal and Torres Strait Islander communities. Health Promot J Austr 2021; 33:261-271. [PMID: 33749952 DOI: 10.1002/hpja.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- David P Thomas
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
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11
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Uppal A, Oxlade O, Nsengiyumva NP, N'Diaye DS, Alvarez GG, Schwartzman K. Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis. BMC Public Health 2021; 21:280. [PMID: 33536003 PMCID: PMC7860224 DOI: 10.1186/s12889-021-10187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting. METHODS We created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars. RESULTS Compared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7-11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5-3%) compared to the tobacco cessation strategy alone, but at significant cost. CONCLUSIONS Strategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security.
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Affiliation(s)
- Aashna Uppal
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Ntwali Placide Nsengiyumva
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
| | - Dieynaba S N'Diaye
- Montreal Chest Institute, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, Department of Medicine, Division of Respirology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Schwartzman
- Montreal Chest Institute, Montreal, Quebec, Canada.
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
- McGill International Tuberculosis Centre, 1001 boulevard Décarie, Room D05.2511, Montréal, Québec, H4A 3J1, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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12
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Improving Aboriginal Maternal Health by Strengthening Connection to Culture, Family and Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249461. [PMID: 33348723 PMCID: PMC7766573 DOI: 10.3390/ijerph17249461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: To explore the function of smoking in Aboriginal women’s lives from a trauma-informed, women-centred approach in order to inform the design of a culturally meaningful smoking cessation program for women living in the Pilbara, Western Australia; (2) Methods: Qualitative and Community Based Participatory Action Research (CBPAR) was used to discover what Aboriginal women know about smoking, the specific contextual issues that influence their smoking, and what community supports are available to help them quit smoking. Inductive analysis was used to determine key themes; (3) Results: 25 Aboriginal women (smokers, non-smokers, and ex-smokers) participated in focus groups or individual interviews. Women smoked to deal with stress, trauma and for maintaining social connections. Women who stopped smoking did so on their own when the reason was important enough or when they saw alternative ways of living. Creating safe places to bring women together to yarn about women’s business and link with health services was identified as critical to support women to stop smoking. Conclusions: Strategies to address smoking need to bring community, culture and health together in a meaningful way for women and their families; build on existing community strengths; and educate communities about the effects of smoking, and health professionals about how to support women to stop smoking.
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Seear KH, Atkinson DN, Lelievre MP, Henderson-Yates LM, Marley JV. Piloting a culturally appropriate, localised diabetes prevention program for young Aboriginal people in a remote town. Aust J Prim Health 2020; 25:495-500. [PMID: 31581978 DOI: 10.1071/py19024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/26/2019] [Indexed: 11/23/2022]
Abstract
Lifestyle changes are central to preventing type 2 diabetes. Embarking upon and sustaining change is challenging, and translation of prevention approaches into a wider range of real-world settings is needed. In this study, a locally adapted community-led diabetes prevention program with local young Aboriginal facilitators was created and trialled through the Derby Aboriginal Health Service (DAHS). The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. Ten Aboriginal women and men aged 18-38 years participated in the pilot program. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. Limitations included participant recruitment and attendance difficulties, which were attributed to program timing and competing demands. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies.
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Affiliation(s)
- Kimberley H Seear
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; and Corresponding author.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
| | - Matthew P Lelievre
- Derby Aboriginal Health Service, 1 Stanley Street (PO Box 1155), Derby, WA 6728, Australia; and Present address: North and West Remote Health, 53 Enid Street (PO Box 1127), Mount Isa, Qld 4825, Australia
| | | | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia; and Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome, WA 6725, Australia
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14
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Bradley K, Smith R, Hughson JA, Atkinson D, Bessarab D, Flicker L, Radford K, Smith K, Strivens E, Thompson S, Blackberry I, LoGiudice D. Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Serv Res 2020; 20:208. [PMID: 32164678 PMCID: PMC7069169 DOI: 10.1186/s12913-020-4985-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. METHODS/DESIGN The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. DISCUSSION The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. TRIAL REGISTRATION ACTRN12618001485224. Date of registration: 04 of September 2019.
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Affiliation(s)
- Kate Bradley
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Robyn Smith
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Jo-anne Hughson
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - David Atkinson
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Dawn Bessarab
- The University of Western Australia, M303, 35 Stirling Highway, Perth, 6009 Australia
| | - Leon Flicker
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Kylie Radford
- Neuroscience Research Australia, 139 Barker Street, Sydney, NSW 2031 Australia
- The School of Medical Sciences, University of New South Wales, Sydney, NSW Australia
| | - Kate Smith
- University of Western Australia, 35 Stirling Highway, Perth, 6009 Australia
| | | | - Sandra Thompson
- The University of Western Australia, 167 Fitzgerald St, Geraldton, WA 6530 Australia
| | | | - Dina LoGiudice
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
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15
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Canuto KJ, Aromataris E, Burgess T, Davy C, McKivett A, Schwartzkopff K, Canuto K, Tufanaru C, Lockwood C, Brown A. A scoping review of Aboriginal and Torres Strait Islander health promotion programs focused on modifying chronic disease risk factors. Health Promot J Austr 2019; 32:46-74. [PMID: 31724783 PMCID: PMC7891321 DOI: 10.1002/hpja.307] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/09/2022] Open
Abstract
Issue addressed Noncommunicable chronic disease underlies much of the life expectancy gap experienced by Aboriginal and Torres Strait Islander people. Modifying contributing risk factors; tobacco smoking, nutrition, alcohol consumption, physical activity, social and emotional wellbeing (SNAPS) could help close this disease gap. This scoping review identified and describes SNAPS health promotion programs implemented for Aboriginal and Torres Strait Islander people in Australia. Methods Databases PubMed, CINAHL, Informit (Health Collection and Indigenous Peoples Collection), Scopus, Trove and relevant websites and clearing houses were searched for eligible studies until June 2015. To meet the inclusion criteria the program had to focus on modifying one of the SNAPS risk factors and the majority of participants had to identify as being of Aboriginal and/or Torres Strait Islander heritage. Results The review identified 71 health promotion programs, described in 83 publications. Programs were implemented across a range of health and community settings and included all Australian states and territories, from major cities to remote communities. The SNAPS factor addressed most commonly was nutrition. Some programs included the whole community, or had multiple key audiences, whilst others focused solely on one subgroup of the population such as chronic disease patients, pregnant women or youth. Fourteen of the programs reported no outcome assessments. Conclusions Health promotion programs for Aboriginal and Torres Strait Islander people have not been adequately evaluated. The majority of programs focused on the development of individual skills and changing personal behaviours without addressing the other health promotion action areas, such as creating supportive environments or reorienting health care services. So What? This scoping review provides a summary of the health promotion programs that have been delivered in Australia for Aboriginal and Torres Strait Islander people to prevent or manage chronic disease. These programs, although many are limited in quality, should be used to inform future programs. To improve evidence‐based health promotion practice, health promotion initiatives need to be evaluated and the findings published publicly.
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Affiliation(s)
- Karla J Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Edoardo Aromataris
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Teresa Burgess
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Carol Davy
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea McKivett
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kate Schwartzkopff
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kootsy Canuto
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia
| | - Catalin Tufanaru
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Lockwood
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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16
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Carlin E, Blondell SJ, Cadet-James Y, Campbell S, Williams M, Engelke C, Taverner D, Marriott R, Edmonds K, Atkinson D, Marley JV. Study protocol: a clinical trial for improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children using the Kimberley Mum's Mood Scale. BMC Public Health 2019; 19:1521. [PMID: 31727039 PMCID: PMC6857148 DOI: 10.1186/s12889-019-7845-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum’s Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the ‘real world’ validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. Methods The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach’s alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. Discussion This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. Trial registration The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).
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Affiliation(s)
- Emma Carlin
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia. .,Kimberley Aboriginal Medical Services, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia.
| | - Sarah J Blondell
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Yvonne Cadet-James
- Apunipima Cape York Health Council, 186 McCoombe Street, PO Box 12045, Bungalow, QLD, 4870, Australia
| | - Sandra Campbell
- Centre for Indigenous Health Equity Research, Central Queensland University, Cnr of Shields and Lake Streets, Cairns, QLD, 4870, Australia
| | - Melissa Williams
- Western Australian Country Health Service - Kimberley Population Health Unit, 4/9 Napier Tce (WA 6725 Locked Bag 525), Broome, WA, 6725, Australia
| | - Catherine Engelke
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Des Taverner
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Rhonda Marriott
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - Karen Edmonds
- King's College London, 1 Lambeth Palace Road, Waterloo, London, SE1 7EU, UK
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
| | - Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia.,Kimberley Aboriginal Medical Services, 12 Napier Tce, PO Box 1377, Broome, WA, 6725, Australia
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Beks H, Binder MJ, Kourbelis C, Ewing G, Charles J, Paradies Y, Clark RA, Versace VL. Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review. BMC Public Health 2019; 19:1115. [PMID: 31412846 PMCID: PMC6694647 DOI: 10.1186/s12889-019-7463-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Targeted chronic disease programs are vital to improving health outcomes for Indigenous people globally. In Australia it is not known where evaluated chronic disease programs for Aboriginal and Torres Strait Islander people have been implemented. This scoping review geographically examines where evaluated chronic disease programs for Aboriginal people have been implemented in the Australian primary health care setting. Secondary objectives include scoping programs for evidence of partnerships with Aboriginal organisations, and use of ethical protocols. By doing so, geographical gaps in the literature and variations in ethical approaches to conducting program evaluations are highlighted. METHODS The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a published protocol. This scoping review was undertaken in accordance with the Joanna Briggs Institute (JBI) scoping review methodology. The search included 11 academic databases, clinical trial registries, and the grey literature. RESULTS The search resulted in 6894 citations, with 241 retrieved from the grey literature and targeted organisation websites. Title, abstract, and full-text screening was conducted by two independent reviewers, with 314 citations undergoing full review. Of these, 74 citations evaluating 50 programs met the inclusion criteria. Of the programs included in the geographical analysis (n = 40), 32.1% were implemented in Major Cities and 29.6% in Very Remote areas of Australia. A smaller proportion of programs were delivered in Inner Regional (12.3%), Outer Regional (18.5%) and Remote areas (7.4%) of Australia. Overall, 90% (n = 45) of the included programs collaborated with an Aboriginal organisation in the implementation and/or evaluation of the program. Variation in the use of ethical guidelines and protocols in the evaluation process was evident. CONCLUSIONS A greater focus on the evaluation of chronic disease programs for Aboriginal people residing in Inner and Outer Regional areas, and Remote areas of Australia is required. Across all geographical areas further efforts should be made to conduct evaluations in partnership with Aboriginal communities residing in the geographical region of program implementation. The need for more scientifically and ethically rigorous approaches to Aboriginal health program evaluations is evident.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | - Marley J Binder
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | - Constance Kourbelis
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Geraldine Ewing
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia
| | - James Charles
- Institute of Koorie Education, Deakin University, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Yin Paradies
- Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Vincent L Versace
- Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia.
- National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia.
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Santos MDDV, Santos SV, Caccia-Bava MDCGG. [The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:563-572. [PMID: 30726388 DOI: 10.1590/1413-81232018242.27712016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.
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Affiliation(s)
- Meire de Deus Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
| | - Stella Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
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Peiris D, Wright L, News M, Rogers K, Redfern J, Chow C, Thomas D. A Smartphone App to Assist Smoking Cessation Among Aboriginal Australians: Findings From a Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12745. [PMID: 30938691 PMCID: PMC6538311 DOI: 10.2196/12745] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/16/2022] Open
Abstract
Background Mobile health (mHealth) apps have the potential to increase smoking cessation, but little research has been conducted with Aboriginal communities in Australia. Objective We conducted a pilot study to assess the feasibility and acceptability and explore the effectiveness of a novel mHealth app to assist Aboriginal people to quit smoking. Methods A pilot randomized controlled trial (RCT) and process evaluation comprising usage analytics data and in-depth interviews was conducted. Current Aboriginal smokers (>16 years old), who were willing to make a quit attempt in the next month, were recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service. The intervention was a multifaceted Android or iOS app comprising a personalized profile and quit plan, text and in-app motivational messages, and a challenge feature allowing users to compete with others. The comparator was usual cessation support services. Outcome data collection and analysis were conducted blinded to treatment allocation. The primary outcome was self-reported continuous smoking abstinence verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. Results A total of 49 participants were recruited. Competing service delivery priorities, the lack of resources for research, and lack of support for randomization to a control group were the major recruitment barriers. At baseline, 23/49 (47%) of participants had tried to quit in recent weeks. At 6-month follow-up, only 1 participant (intervention arm) was abstinent. The process evaluation highlighted low to moderate app usage (3-10 new users per month and 4-8 returning users per month), an average of 2.9 sessions per user per month and 6.3 min per session. Key themes from interviews with intervention participants (n=15) included the following: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text, and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilization of smoking cessation support services. Despite the broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customization of text messages, integration with existing social media platforms, and gamification features. Conclusions Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have the potential to increase utilization of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact; however, an RCT design may not be feasible in this setting. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12616001550493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371792 (Archived by WebCite at http://www.webcitation.org/76TiV7HA6).
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Affiliation(s)
- David Peiris
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Lachlan Wright
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Madeline News
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Kris Rogers
- The George Institute for Global Health, UNSW Sydney, Newtown, Australia
| | - Julie Redfern
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Clara Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - David Thomas
- Menzies School of Health Research, Darwin, Australia
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N’Diaye DS, Nsengiyumva NP, Uppal A, Oxlade O, Alvarez GG, Schwartzman K. The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities. BMC Med 2019; 17:26. [PMID: 30712513 PMCID: PMC6360759 DOI: 10.1186/s12916-019-1261-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/15/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities. METHODS Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20 years. RESULTS The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9-7.0%) and TB deaths by 10.4% (9.5-11.4%) over 20 years, relative to the status quo. Increased taxation was the only cost-saving strategy. CONCLUSIONS Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.
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Affiliation(s)
- Dieynaba S. N’Diaye
- Montreal Chest Institute, Montreal, Quebec Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1001 boulevard Décarie, Room D05.2511, Montreal, Quebec H4A 3J1 Canada
- McGill International Tuberculosis Centre, Montreal, Quebec Canada
| | - Ntwali Placide Nsengiyumva
- Montreal Chest Institute, Montreal, Quebec Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1001 boulevard Décarie, Room D05.2511, Montreal, Quebec H4A 3J1 Canada
- McGill International Tuberculosis Centre, Montreal, Quebec Canada
| | - Aashna Uppal
- Montreal Chest Institute, Montreal, Quebec Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1001 boulevard Décarie, Room D05.2511, Montreal, Quebec H4A 3J1 Canada
- McGill International Tuberculosis Centre, Montreal, Quebec Canada
| | - Olivia Oxlade
- Montreal Chest Institute, Montreal, Quebec Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1001 boulevard Décarie, Room D05.2511, Montreal, Quebec H4A 3J1 Canada
- McGill International Tuberculosis Centre, Montreal, Quebec Canada
| | - Gonzalo G. Alvarez
- The Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Department of Medicine, Division of Respirology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario Canada
| | - Kevin Schwartzman
- Montreal Chest Institute, Montreal, Quebec Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1001 boulevard Décarie, Room D05.2511, Montreal, Quebec H4A 3J1 Canada
- McGill International Tuberculosis Centre, Montreal, Quebec Canada
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Graham VE, Clough AR. "Need Everyone Helping to Keep Off Because Everyone Helping to Keep On" - Reducing Harms from Cannabis use in Remote Indigenous Australian Communities Involves More Than Just Users. Subst Use Misuse 2019; 54:699-712. [PMID: 30794014 DOI: 10.1080/10826084.2018.1504078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Heavy cannabis use in remote Indigenous Australian communities potentially contributes to existing health disparities. Community members' perceptions of cannabis harms will support harm-minimization in these settings. OBJECTIVE To describe perceived cannabis harms reported by a cohort of Indigenous Australians living in small, isolated communities as an indication of their existing resources for change. METHOD Inductive thematic analysis of 407 semi-structured interviews with participants in a cohort study in three remote communities in Cape York in far north Queensland (Australia) revealed major areas of concern about cannabis. Three attitudinal categories were defined according to reported cannabis impacts and urgency for change: 1- "LOW CONCERN" said cannabis was a low priority community issue; 2- "SOME CONCERN" tolerated cannabis use but identified personal or community-level concerns; and 3- "HIGH CONCERN" expressed strong aversion to cannabis and identified serious personal or community-level harms. The characteristics and the patterns of concerns were summarized across the groups. RESULTS "Category 1- LOW CONCERN" (n = 107), mostly current users, emphasized personal "financial impacts" and "stress." "Category 2 - SOME CONCERN" (n = 141) perceived community level impacts warranting systematic action, particularly on "employment"; and "Category 3 - HIGH CONCERN" (n = 159), most of the never users, emphasized concerns for families and youth. Irrespective of use history, the cohort reported financial and abstinence-related stress, overlapping alcohol issues and generally endorsed alleviating impacts on children and youth. CONCLUSION Nearly ubiquitous experience with cannabis harms and impacts in this cohort suggests resources for harm reduction including family and cultural obligation, stress relief, financial management, and engagement are available across all community members, not just users.
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Affiliation(s)
- Veronica E Graham
- a James Cook University , Australian Institute of Tropical Health and Medicine , Cairns , Australia
| | - Alan R Clough
- a James Cook University , Australian Institute of Tropical Health and Medicine , Cairns , Australia
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Boland VC, Mattick RP, McRobbie H, Siahpush M, Courtney RJ. "I'm not strong enough; I'm not good enough. I can't do this, I'm failing"- A qualitative study of low-socioeconomic status smokers' experiences with accesssing cessation support and the role for alternative technology-based support. Int J Equity Health 2017; 16:196. [PMID: 29132364 PMCID: PMC5683575 DOI: 10.1186/s12939-017-0689-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/30/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The social gradient in smoking rates persist with an overrepresentation of smoking and its associated harms concentrated within lower socioeconomic status (SES) populations. Low-SES smokers are motivated to quit but face multiple barriers when engaging a quit attempt. An understanding of the current treatment service model from the perspectives of treatment-seeking low-SES smokers is needed to inform the design of alternative smoking cessation support services tailored to the needs of low-SES populations. This qualitative study aimed to: i) explore low-SES smokers' recent quitting experiences; ii) assess factors that impact treatment engagement; and iii) determine the acceptability and feasibility of alternative approaches to smoking cessation. METHOD Low-SES participants (n = 24) previously enrolled in a smoking cessation RCT participated in either a semi-structured focus group or in-depth telephone interview. Data was obtained and analysed using thematic analysis from October 2015 to June 2016. Analysis was deductive from the interview guide and supplemented inductively. RESULTS Participants expressed feelings of guilt and shame around their smoking behaviour and experienced stigmatisation for their smoking. Guilt, shame, and stigmatisation negatively impacted treatment seeking behaviours with most avoiding current quit services. Costs of pharmacotherapy and treatment adherence were commonly cited barriers to treatment success. Electronic-cigarettes were perceived to be unsafe due to uncertainty on their legal status and regulatory restrictions. Technology-based text-messaging quit support was endorsed as a more favourable alternative compared to existing behavioural treatment services. CONCLUSION Stigmatisation was commonly endorsed and acted as an impediment to current treatment utilisation. Electronic-cigarettes may present a viable harm reduction alternative, but their likely uptake in socioeconomically disadvantaged groups in Australia is limited by smokers' uncertainty about their regulation and legality. Mobile phone based cessation support may provide an alternative to telephone counselling and overcome the stigmatisation low-SES smokers face while trying to quit.
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Affiliation(s)
- Veronica C. Boland
- University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW 2031 Australia
| | - Richard P. Mattick
- University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW 2031 Australia
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, EC1M 6BQ, London, UK
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Ryan J. Courtney
- University of New South Wales (UNSW), National Drug and Alcohol Research Centre (NDARC), 22-32 King Street, Randwick, NSW 2031 Australia
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Lokuge K, Thurber K, Calabria B, Davis M, McMahon K, Sartor L, Lovett R, Guthrie J, Banks E. Indigenous health program evaluation design and methods in Australia: a systematic review of the evidence. Aust N Z J Public Health 2017; 41:480-482. [DOI: 10.1111/1753-6405.12704] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kamalini Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health; The Australian National University; Australian Capital Territory
| | - Katherine Thurber
- National Centre for Epidemiology and Population Health, Research School of Population Health; The Australian National University; Australian Capital Territory
| | - Bianca Calabria
- National Centre for Epidemiology and Population Health, Research School of Population Health; The Australian National University; Australian Capital Territory
| | - Meg Davis
- Medical School; The Australian National University; Australian Capital Territory
| | - Kathryn McMahon
- Medical School; The Australian National University; Australian Capital Territory
| | - Lauren Sartor
- Medical School; The Australian National University; Australian Capital Territory
| | - Raymond Lovett
- National Centre for Epidemiology and Population Health, Research School of Population Health; The Australian National University; Australian Capital Territory
| | - Jill Guthrie
- National Centre for Epidemiology and Population Health, Research School of Population Health; The Australian National University; Australian Capital Territory
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health; The Australian National University; Australian Capital Territory
- Sax Institute; New South Wales
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Graham VE, Campbell S, West C, Clough AR. Substance misuse intervention research in remote Indigenous Australian communities since the NHMRC ‘Roadmap’. Aust N Z J Public Health 2017; 41:424-431. [DOI: 10.1111/1753-6405.12691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 04/01/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Veronica E. Graham
- Australian Institute of Tropical Health and Medicine; James Cook University; Queensland
| | - Sandra Campbell
- Centre for Chronic Disease Prevention; James Cook University; Queensland
| | - Caryn West
- School of Nursing, Midwifery & Nutrition; James Cook University; Queensland
| | - Alan R. Clough
- Australian Institute of Tropical Health and Medicine; James Cook University; Queensland
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Wilson A, Guillaumier A, George J, Denham A, Bonevski B. A systematic narrative review of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups (2010-2017). Expert Rev Respir Med 2017; 11:617-630. [PMID: 28608758 DOI: 10.1080/17476348.2017.1340836] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Tobacco remains the key modifiable risk factor for the development of a number of diseases, including cardiovascular disease, cerebrovascular disease, lower respiratory infections, chronic obstructive pulmonary disease, tuberculosis and cancer. Among priority populations, smoking prevalence remains high, smokers tend to relapse more often and earlier and fewer are able to sustain quit attempts. This systematic review provides an update on the literature. Areas covered: Twenty-four randomized controlled trials published from 2010-2017, in English language, were identified after searching on Medline, Ovid, Embase and PsycINFO databases. Studies reported on the effectiveness of smoking cessation interventions among six disadvantaged groups known to have high smoking rates: (i) homeless, (ii) prisoners, (iii) indigenous populations, (iv) at-risk youth, (v) people with low income, and (vi) those with a mental illness. Narrative review and assessment of methodological quality of included papers was undertaken. Expert commentary: There is a growing evidence base of methodologically robust studies evaluating a variety of behavioural smoking cessation interventions for priority populations. Multi-component interventions and those examining behavioural interventions incorporating mindfulness training, financial incentives, motivational interviewing and extended telephone-delivered counseling may be effective in the short-term, particularly for smokers on low incomes and people with a mental illness.
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Affiliation(s)
- Amanda Wilson
- a School of Nursing and Midwifery, Faculty of Health and Medicine , University of Newcastle , Callaghan , NSW , USA
| | - Ashleigh Guillaumier
- b School of Medicine and Public Health, Faculty of Health and Medicine , University of Newcastle & Hunter Medical Research Institute , Waratah , NSW , USA
| | - Johnson George
- c Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences , Monash University , Parkville , VIC , USA
| | - Alexandra Denham
- d School of Medicine and Public Health, Faculty of Health and Medicine , University of Newcastle & Hunter Medical Research Institute , Waratah , NSW , USA
| | - Billie Bonevski
- e School of Medicine and Public Health, Faculty of Health and Medicine , University of Newcastle & Hunter Medical Research Institute , Waratah , NSW , USA
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Gould GS, Patten C, Glover M, Kira A, Jayasinghe H. Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review. Nicotine Tob Res 2017; 19:506-517. [PMID: 28403465 PMCID: PMC5896479 DOI: 10.1093/ntr/ntw288] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 02/08/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies. METHODS As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research. RESULTS Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches. CONCLUSIONS Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted. IMPLICATIONS Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Marewa Glover
- School of Public Health, College of Health, Massey University, Auckland, New Zealand
| | - Anette Kira
- Independent Researcher, Manawatu, New Zealand
| | - Harshani Jayasinghe
- University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
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Abstract
BACKGROUND Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. OBJECTIVES The review addresses the following hypotheses:1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.2. Individual counselling is more effective than self-help materials in promoting smoking cessation.3. A more intensive counselling intervention is more effective than a less intensive intervention. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with counsel* in any field in May 2016. SELECTION CRITERIA Randomized or quasi-randomized trials with at least one treatment arm consisting of face-to-face individual counselling from a healthcare worker not involved in routine clinical care. The outcome was smoking cessation at follow-up at least six months after the start of counselling. DATA COLLECTION AND ANALYSIS Both authors extracted data in duplicate. We recorded characteristics of the intervention and the target population, method of randomization and completeness of follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically-validated rates where available. In analysis, we assumed that participants lost to follow-up continued to smoke. We expressed effects as a risk ratio (RR) for cessation. Where possible, we performed meta-analysis using a fixed-effect (Mantel-Haenszel) model. We assessed the quality of evidence within each study using the Cochrane 'Risk of bias' tool and the GRADE approach. MAIN RESULTS We identified 49 trials with around 19,000 participants. Thirty-three trials compared individual counselling to a minimal behavioural intervention. There was high-quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self-help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% confidence interval (CI) 1.40 to 1.77; 27 studies, 11,100 participants; I2 = 50%). There was moderate-quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (nicotine replacement therapy) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I2 = 0%). There was moderate-quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I2 = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. AUTHORS' CONCLUSIONS There is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit. There is moderate-quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention.
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Affiliation(s)
- Tim Lancaster
- King’s College LondonGKT School of Medical EducationLondonUK
| | - Lindsay F Stead
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Windle SB, Filion KB, Mancini JG, Adye-White L, Joseph L, Gore GC, Habib B, Grad R, Pilote L, Eisenberg MJ. Combination Therapies for Smoking Cessation: A Hierarchical Bayesian Meta-Analysis. Am J Prev Med 2016; 51:1060-1071. [PMID: 27617367 DOI: 10.1016/j.amepre.2016.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/17/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Treatment guidelines recommend the use of combination therapies for smoking cessation, particularly behavioral therapy (BT) as an adjunct to pharmacotherapy. However, these guidelines rely on previous reviews with important limitations. This study's objective was to evaluate the efficacy of combination therapies compared with monotherapies, using the most rigorous data available. EVIDENCE ACQUISITION A systematic review and meta-analysis of RCTs of pharmacotherapies, BTs, or both were conducted. The Cochrane Library, Embase, PsycINFO, and PubMed databases were systematically searched from inception to July 2015. Inclusion was restricted to RCTs reporting biochemically validated abstinence at 12 months. Direct and indirect comparisons were made in 2015 between therapies using hierarchical Bayesian models. EVIDENCE SYNTHESIS The search identified 123 RCTs meeting inclusion criteria (60,774 participants), and data from 115 (57,851 participants) were meta-analyzed. Varenicline with BT increased abstinence more than other combinations of a pharmacotherapy with BT (varenicline versus bupropion: OR=1.56, 95% credible interval [CrI]=1.07, 2.34; varenicline versus nicotine patch: OR=1.65, 95% CrI=1.10, 2.51; varenicline versus short-acting nicotine-replacement therapies: OR=1.68, 95% CrI=1.15, 2.53). Adding BT to any pharmacotherapy compared with pharmacotherapy alone was inconclusive, owing to wide CrIs (OR=1.17, CrI=0.60, 2.12). Nicotine patch with short-acting nicotine-replacement therapy appears safe and increases abstinence versus nicotine-replacement monotherapy (OR=1.63, CrI=1.06, 3.03). Data are limited concerning other pharmacotherapy combinations and their safety and tolerability. CONCLUSIONS Evidence suggests that combination therapy benefits may be less than previously thought. Combined with BT, varenicline increases abstinence more than other pharmacotherapy with BT combinations.
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Affiliation(s)
- Sarah B Windle
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joseph G Mancini
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Lauren Adye-White
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Genevieve C Gore
- Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
| | - Bettina Habib
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Roland Grad
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Louise Pilote
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada.
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Minichiello A, Lefkowitz ARF, Firestone M, Smylie JK, Schwartz R. Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review. BMC Public Health 2016; 16:21. [PMID: 26754922 PMCID: PMC4710008 DOI: 10.1186/s12889-015-2645-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background All over the world, Indigenous populations have remarkably high rates of commercial tobacco use compared to non-Indigenous groups. The high rates of commercial tobacco use in Indigenous populations have led to a variety of health issues and lower life expectancy than the general population. The objectives of this systematic review were to investigate changes in the initiation, consumption and quit rates of commercial tobacco use as well as changes in knowledge, prevalence, community interest, and smoke-free environments in Indigenous populations. We also aimed to understand which interventions had broad reach, what the common elements that supported positive change were and how Aboriginal self-determination was reflected in program implementation. Methods We undertook a systematic review of peer-reviewed publications and grey literature selected from seven databases and 43 electronic sources. We included studies between 1994 and 2015 if they addressed an intervention (including provision of a health service or program, education or training programs) aimed to reduce the use of commercial tobacco use in Indigenous communities globally. Systematic cross-regional canvassing of informants in Canada and internationally with knowledge of Indigenous health and/or tobacco control provided further leads about commercial tobacco reduction interventions. We extracted data on program characteristics, study design and learnings including successes and challenges. Results In the process of this review, we investigated 73 commercial tobacco control interventions in Indigenous communities globally. These interventions incorporated a myriad of activities to reduce, cease or protect Indigenous peoples from the harms of commercial tobacco use. Interventions were successful in producing positive changes in initiation, consumption and quit rates. Interventions also facilitated increases in the number of smoke-free environments, greater understandings of the harms of commercial tobacco use and a growing community interest in addressing the high rates of commercial tobacco use. Interventions were unable to produce any measured change in prevalence rates. Conclusions The extent of this research in Indigenous communities globally suggests a growing prioritization and readiness to address the high rates of commercial tobacco use through the use of both comprehensive and tailored interventions. A comprehensive approach that uses multiple activities, the centring of Aboriginal leadership, long term community investments, and the provision of culturally appropriate health materials and activities appear to have an important influence in producing desired change. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2645-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexa Minichiello
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Ayla R F Lefkowitz
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Michelle Firestone
- Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing,, St. Michael's Hospital, Toronto, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Janet K Smylie
- Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing,, St. Michael's Hospital, Toronto, Canada. .,Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Robert Schwartz
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Eades SJ, Chamberlain C. Seeking a comprehensive approach to tobacco control for Aboriginal and Torres Strait Islander people. Med J Aust 2015; 202:511-2. [PMID: 26027693 DOI: 10.5694/mja15.00455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Sandra J Eades
- Baker IDI Heart and Diabetes Institute, Sydney, NSW, Australia.
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Daoud N, Hayek S, Sheikh Muhammad A, Abu-Saad K, Osman A, Thrasher JF, Kalter-Leibovici O. Stages of change of the readiness to quit smoking among a random sample of minority Arab male smokers in Israel. BMC Public Health 2015; 15:672. [PMID: 26178347 PMCID: PMC4607270 DOI: 10.1186/s12889-015-1950-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite advanced smoking prevention and cessation policies in many countries, the prevalence of cigarette smoking among indigenous and some ethnic minorities continues to be high. This study examined the stages of change (SOC) of the readiness to quit smoking among Arab men in Israel shortly after new regulations of free-of-charge smoking cessation workshops and subsidized medications were introduced through primary health care clinics. METHODS We conducted a countrywide study in Israel between 2012-2013. Participants, 735 current smokers; 18-64 years old; were recruited from a stratified random sample and interviewed face-to-face using a structured questionnaire in Arabic. We used ordered regression to examine the contribution of socio-economic position (SEP), health status, psychosocial attributes, smoking-related factors, and physician advice to the SOC of the readiness to quit smoking (pre-contemplation, contemplation and preparation). RESULTS Of the current smokers, 61.8% were at the pre-contemplation stage, 23.8% were at the contemplation stage, and only 14.4% were at the preparation stage. In the multinomial analysis, factors significantly (P < 0.05) contributing to contemplation stage compared to pre-contemplation stage included [odds ratio (OR), 95% confidence interval (CI)]: chronic morbidity [0.52, (0.31-0.88)], social support [1.35, (1.07-1.70)], duration of smoking for 11-21 years [1.94, (1.07-3.50)], three or more previous attempts to quit [2.27, (1.26-4.01)], knowledge about smoking hazards [1.75, (1.29-2.35)], positive attitudes toward smoking prevention [1.44, (1.14-1.82)], and physician advice to quit smoking [1.88, (1.19-2.97)]. The factors significantly (P < 0.05) contributing to preparation stage compared to pre-contemplation stage were [OR, (95 % CI)]: chronic morbidity [0.36, (0.20-0.67)], anxiety [1.07, (1.01-1.13)], social support [1.34, (1.01-1.78)], duration of smoking 5 years or less [2.93, (1.14-7.52)], three or more previous attempts to quit [3.16, (1.60-6.26)], knowledge about smoking hazards [1.57, (1.10-2.21)], and positive attitudes toward smoking prevention [1.34, (1.00-1.82)]. CONCLUSIONS Most Arab men who currently smoke are in the pre-contemplation stage, indicating low readiness to quit smoking. New policies of free-of-charge smoking-cessation group sessions and subsidized medications introduced through primary health care clinics in Israel may be less effective among Arab men. For these policies to promote cessation more successfully, tailored interventions and campaigns may be needed to increase the readiness to quit smoking in this population, especially for those at the pre-contemplation stage.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel.
| | - Samah Hayek
- School of Public Health. University of Haifa, Haifa, Israel.
| | - Ahmad Sheikh Muhammad
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel.
| | - Kathleen Abu-Saad
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621, Israel.
| | - Amira Osman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA.
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA.
| | - Ofra Kalter-Leibovici
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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32
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Thomas DP, Bennet PT, Briggs VL, Couzos S, Hunt JM, Panaretto KS, Stevens M, Borland R. Smoking cessation advice and non‐pharmacological support in a national sample of Aboriginal and Torres Strait Islander smokers and ex‐smokers. Med J Aust 2015; 202:S73-7. [DOI: 10.5694/mja15.00293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | - Pele T Bennet
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD
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Mc Loughlin F, Hadgraft NT, Atkinson D, Marley JV. Aboriginal health research in the remote Kimberley: an exploration of perceptions, attitudes and concerns of stakeholders. BMC Health Serv Res 2014; 14:517. [PMID: 25343849 PMCID: PMC4213490 DOI: 10.1186/s12913-014-0517-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background For decades Indigenous peoples have argued for health research reform claiming methods used and results obtained often reflect the exploitative history of colonisation. In 2006 the Kimberley Aboriginal Health Planning Forum (KAHPF) Research Subcommittee (hereafter, the Subcommittee) was formed to improve research processes in the remote Kimberley region of north Western Australia. This paper explores the major perceptions, attitudes and concerns of stakeholders in the Subcommittee. Methods Qualitative analysis was carried out on data retrospectively collected from multiple evidentiary sources linked to the Subcommittee i.e. database, documents, interviews, review forms and emails from 1 January 2007 to 31 October 2013. Results From 1 January 2007 to 30 June 2013 the Subcommittee received 95 proposals, 57 (60%) driven by researchers based outside the region. Local stakeholders (22 from 12 different Kimberley organisations) raised concerns about 36 (38%) projects, 30 (83%) of which were driven by external researchers. Major concerns of local stakeholders were inadequate community consultation and engagement; burden of research on the region; negative impact of research practices; lack of demonstrable community benefit; and power and control of research. Major themes identified by external stakeholders (25 external researchers who completed the review form) were unanticipated difficulties with consultation processes; barriers to travel; perceiving research as a competing priority for health services and time-consuming ethics processes. External stakeholders also identified strategies for improving research practices in the Kimberley: importance of community support in building good relationships; employing local people; flexibility in research approaches; and importance of allocating sufficient time for consultation and data collection. Conclusions Health research in the Kimberley has improved in recent years, however significant problems remain. Prioritising research addressing genuine local needs is essential in closing the gap in Indigenous life expectancy. The long-term aim is for local health service connected researchers to identify priorities, lead, conduct and participate in the majority of local health research. For this to occur, a more radical move involving reconceptualising the research process is needed. Changes to institutional timeframes and funding processes could improve Indigenous and community-based research.
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Affiliation(s)
- Frieda Mc Loughlin
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - Nyssa T Hadgraft
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - David Atkinson
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia. .,The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
| | - Julia V Marley
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia. .,The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA, 6725, Australia.
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Marley JV, Kitaura T, Atkinson D, Metcalf S, Maguire GP, Gray D. Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study. BMC Public Health 2014; 14:579. [PMID: 24912949 PMCID: PMC4064520 DOI: 10.1186/1471-2458-14-579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. METHODS Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. RESULTS Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. CONCLUSIONS The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation.
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Affiliation(s)
- Julia V Marley
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Tracey Kitaura
- Derby Aboriginal Health Service, 1 Stanley Street, PO Box 1155, Derby, Western Australia 6728, Australia
| | - David Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Sue Metcalf
- Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia
| | - Graeme P Maguire
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia
- Baker IDI, Alice Springs, Northern Territory 0871, Australia
| | - Dennis Gray
- National Drug Institute, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
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