Reflections on tackling tobacco: A call to arms for remote area nurses
Senior Research Officer, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns QLD
Tobacco-related conditions contribute significantly to the health gap between Indigenous and non-Indigenous Australians. Smoking rates in Australia's Indigenous population has failed to decline even though smoking rates in Australia have declined in general. In some Indigenous communities, smoking rates remain very high. This paper outlines a project undertaken to investigate appropriate strategies to assist Indigenous smokers to quit and outlines the important role nurses can play in this area of practice.
tobacco, interventions, Indigenous, remote, nurses
Tobacco-related conditions such as cardiovascular disease, chronic respiratory diseases, diabetes and cancer contribute significantly to the health gap between Indigenous and non-Indigenous Australians (Vos 2003). While smoking rates in Australia have halved in the past thirty years, eventually falling below 20% in 2004, smoking rates remain at around 50% in the Australian Indigenous population (Australian Institute of Health and Welfare 2005). In fact, extraordinarily high rates of smoking have changed little in the 'Top End' region of the Northern Territory (NT) over the past 20 years (Baker 2006; Clough 2002). In the opening keynote speech of the 2010 Oceania Tobacco Control Conference Australia's then Aboriginal and Torres Strait Islander Social Justice Commissioner, Mr Tom Calma, declared "it cannot be said loudly enough - smoking is the single most devastating cause of death and disease among our peoples" (Calma 2009).
While there is ample evidence for the effectiveness of interventions for reducing smoking in mainstream populations, it is not known whether these interventions work in Australia's Indigenous populations (Ivers 2004). Many of these interventions have either not been tried or have not been rigorously evaluated in Indigenous communities (Ivers 2006). There is currently little evidence for successful smoking reduction programs in these settings. In order to contribute to the evidence-base the five year Top End Tobacco Project (TETP) was commenced in July 2007 (National Health and Medical Research Council project grant #436012). The project aims to reduce smoking in three remote communities in the NT's Top End. I am a registered nurse and Senior Research Officer on this project. I am concurrently undertaking post-graduate research for a Professional Doctorate in Public Health. An essential component of my role has been to establish and maintain engagement with community members and key community groups, including liaison with government and non-government agencies and service providers. I have assisted with the baseline survey and have a lead role in establishing and maintaining the intervention components. The process evaluation component of the study is my responsibility.
In this discussion paper I briefly examine the approach of the TETP, my role in the project and learnings to date based on preliminary results and observations. I also reflect on the considerable challenges in the provision of tobacco interventions and discuss modest successes achieved in tackling smoking in these communities. In a 'call-to-arms', I urge remote area nurses to consider taking on these challenges in their routine practice aiming for even greater success. Implications for the role of nurses working in remote settings in addressing tobacco-related issues are discussed.
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