Transcript Document

The Smoke Ring:
Smoking among Indigenous Australians
Raglan Maddox MPH, PhD Candidate | University of Canberra
Chanel Webb Tobacco Action Worker | Winnunga Nimmityjah Aboriginal Health Service
Perri Chapman Tobacco Action Worker | Winnunga Nimmityjah Aboriginal Health Service
Disclaimer
I would like to declare that the findings I am presenting today
reflect my own personal views, based on research findings and
relevant evidence, and in no way reflect the views of any
personal relationships, affiliations or associations that I have,
which may give rise to any actual or perceived conflict of
interest.
What we will cover today?
• Background – smoking
• The Smoke Ring study
• Preliminary findings
• No More Boondah
• Conclusions
Chronic disease risk factors - 2010
ABS National Health Survey Data
National Aboriginal and Torres Strait Islander Health Survey Data
Indigenous tobacco
control initiative
commenced
March 2008
55
50
12.5% tax excise:
1 December 2013
ACT Aboriginal and
Torres Strait Islander
Tobacco Control
Strategy 2010-14
45
40
Advertising ban
in print media
Tobacco Advertising
Prohibition Act
35
per cent
National Tobacco
Campaign
Point-of-sale
advertising bans
National Tackling
Indigenous Smoking
Initiative
30
NPA on
Closing The Gap
1 July 2009
25
Excise rise
Point-of-sale
display bans
Quitline
enhancement
20
Health warnings on packs
25% excise rise
15
Smoke-free dining
Graphic health warnings
on packs
10
1990
1995
2000
2005
Plain packaging and
larger health warnings
2010
Aboriginal and Torres Strait Islander smoking story
Aboriginal and Torres Strait Islander
Non-Indigenous
60.0
54.6
50.0
48.9
48.5
44.7
40.0
30.0
27.0
22.5
20.0
20.1
19.0
20.8
18.8
10.0
10.8
5.4
0.0
15-17
18-24
25-34
35-44
Source: ABS Aboriginal and Torres Strait Islander Health Survey 2012-13
*Data for non-Indigenous people are for 2011-12, from the Australian Health Survey 2011-13.
45-54
55 years and over
Aunty Lorraine Webb
Wiradjuri & Ngunnawal woman from Cowra, NSW, Australia.
Aims and objectives
• Gain a deeper understanding of the factors that
influence smoking:
– is there an association between social and cultural
factors and smoking?
– do social networks influence smoking behaviours?
• Evaluation
The sample
Survey
Key informant interviews
Focus groups participants
Participants (n)
204
10
40 (3 focus groups)
Indigenous Smokers (%)
36.4% (95% CI, 27.8–44.9)
50%
<50%
Indigenous (%)
84%
100%
100%
Male (%)
35%
40%
≈50%
Female (%)
65%
60%
≈50%
Mean age
35.2 years
Not collected
Not collected
Age range
12 to 75 years
≈20 to ≈60 years
12 to ≈ 60 years
Pregnant (%)
Not collected
30%
Not collected
Median household income from all
$67,600-$83,199 p/a ($1,300-
Not collected
Not collected
sources
$1,599/week)
Median household size
2 people
Not collected
Not collected
Household size range
1 – 7 people
Not collected
Not collected
Indigenous participants:
47%
Not collected
Not collected
Yr 12 completed (%)
Preliminary findings: overview
• 36.4% (95% CI, 27.8–44.9) Aboriginal and Torres Strait
Islander people were smokers vs. 11.7% of all ACT
residents
• 95% (95% CI, 91.2–98.1) of participants aged 12 and
over found it ‘very easy’ or ‘fairly easy’ to get tobacco
• 41% of smokers could not cut back or quit
• 92% (95% CI, 88.3–99.5) of smokers would like to stop
smoking
Preliminary analysis
The model contained 10 independent variables:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
age;
smoking status of the five closest friends and family;
education - Year 12 or equivalent (highschool in the US);
employment status;
gender;
attendance of a cultural event in the last 12 months;
household income;
proportion of friends that smoke;
proportion of housemates that smoke; and
total number of nominated friends that smoke.
Preliminary analysis:
Log Regression
• The model was statistically significant
χ2 (5, N = 49) = 28.491, p < .001, indicating that the
model could distinguish between smoking and nonsmoking participants.
• Explained between 44% (Cox and Snell R square) &
59% (Nagelkerke R squared) of the variance in smoking
status, and correctly classified 82% of cases.
• Only two of the independent variables made a unique,
statistically significant contribution to the model:
– completing Year 12 or equivalent
– proportion of housemates that smoke
Preliminary analysis:
Log Regression
Variables in the Equation
B
S.E.
Wald
df
Sig.
Exp(B)
95% C.I. for EXP(B)
Lower
Upper
Age
1.703
.998
2.913
1
.088
5.493
.777
38.845
Five closest friends and
2.064
1.242
2.762
1
.097
7.875
.691
89.795
3.068
1.020
9.051
1
.003
21.502
2.913
158.699
.462
1.360
.115
1
.734
1.587
.110
22.822
-1.911
1.224
2.436
1
.119
.148
.013
1.630
-.471
1.145
.169
1
.681
.624
.066
5.888
Household income
-.951
.954
.994
1
.319
.386
.060
2.506
Number of friends that
-.724
.513
1.997
1
.158
.485
.177
1.323
-.115
1.297
.008
1
.930
.892
.070
11.336
2.466
1.234
3.995
1
.046
11.776
1.049
132.183
-1.921
1.182
2.641
1
.104
.146
family smoking status
Year 12 or equivalent
Unemployed
Gender
Attended a cultural event in
the last 12 months
smoke
Proportion of friends that
smoke
Proportion of housemates
that smoke
Constant
Social Network Analysis
Total network
Smokers
Non-smokers
Nodes
871
257
456
Number of ties
1368
181
255
Males (%)
40.7
38.3
44.3
Females (%)
59.3
61.7
55.7
Mean
35.2
35.0
43.1
Median
34.0
31.0
43.5
Mode
24.0
29.0
42.0
Mean proportion of friends that smoke (%)
55.94 (N =161)
70.83
50.58
Mean proportion of housemates that smoke (%)
26.73 (N =179)
44.32
20.93
Mean proportion of social network that smokes (%)
39.83 (N =190)
56.95
33.44
Network diameter
31
8
8
Average Path Length
10.993
2.805
2.678
APL - Natural Log n
6.770
5.549
6.122
Overall graph clustering coefficient
0.022
0.057
0.008
Weighted Overall graph clustering coefficient
0.025
0.034
0.002
Gender
Age
Clustering coefficient
Total network by smoking status, gender and ties
Smoking network by gender and ties
Non-smoking network by gender and ties
Average: smoker vs non-smoker
Nonsmoker
Nonsmoker
Nonsmoker
Smoker
Smoker
Nonsmoker
Smoker
Smoker
Smoker
Smoker
Smoker
Smoker
Preliminary findings:
“Social lubricant”
“I think she hated me too,
for not smoking, when she
was [still] smoking”
“smoking is seen as an
everyday, acceptable or
'normalised' behaviour
within our communities.
Children raised in this
environment will often see
smoking as just another
part of becoming an adult,
and so the cycle
continues…”
“…I think it’s the influence
of their parents, their
grandparents, their aunts,
their uncles who have
smoked for years …
and I’ve been smoking since
I was about 11, I spose…”
What is
No More Boondah?
A quit smoking program developed by Winnunga
that aims to:
• support, encourage and facilitate quit attempts
• educate on the harms of tobacco and addiction
• promote smoke free spaces and workplaces
No More Boondah
• Phone and group support
• Outreach and education
• Facilitates access to
pharmacotherapy
• Transport to attend weekly group
• Trained tobacco workers
Why does No More Boondah work?
• Coordinated for and by local Aboriginal people
• Provides strategies for change and to support social change
• Clients can return to the program as often as necessary
• Non-judgmental and flexible environment
• Transport and home visits available
• Facilitate delivery of quit aids to clients when they are not able
to access the service
• Evaluation and ongoing improvement
Conclusions
• Locally tailored programs and local engagement to meet
local community needs
• Strategies for change and support for social change
• Build on what’s been done - good work has been
undertaken but more work is required
“Evidence builds confidence and confidence inspires
commitment”
Acknowledgements
 We would like to acknowledge and thank the
Aboriginal and Torres Strait Islander community
for their feedback, support, participation, time and willingness to
contribute to the process.
 We would also like to acknowledge the ACT Aboriginal and Torres Strait
Islander Tobacco Control Advisory Group and the following people:
–
–
–
–
–
–
Dr Tom Calma AO, Chancellor & National Coordinator Tackling Indigenous Smoking
Dr Ray Lovett PhD, MAE, AIATSIS & Australian National University
Ms Anke van der Sterren, Centre for Excellence in Indigenous Tobacco Control
Prof. Rachel Davey PHD, University of Canberra
Prof. Tom Cochrane PHD, University of Canberra
Ms Joan Corbett, University of Canberra
 This research is funded by the ACT Government