8.9 Attitudes to and beliefs about smoking

Show / hide chapter menu

8.9.1 Why do Aboriginal and Torres Strait Islander people smoke?

The early sections of this chapter present a range of unique cultural and historical reasons, as well as socioeconomic factors contributing to higher rates of smoking among the Aboriginal and Torres Strait Islander communities. Inasmuch as smoking may be interpreted as a symptom of, and a method for coping with disadvantage, care should be taken to ensure that Indigenous people are not blamed for their smoking behaviour.112

In addition to these factors, members of the Aboriginal and Torres Strait Islander communities nominate many of the same reasons that the rest of the Australian population give for smoking. Lighting up a cigarette serves many different social and emotional functions in smokers' lives, whether it be as a dependable part of daily routine, a consolation in bad times, or an aid to relaxation.113 Both the National Aboriginal and Torres Strait Islander Tobacco Control Project (NATSITCP)6 and The Forgotten Smokers,112 a report jointly commissioned by the Australian Medical Association and the Australian Pharmaceutical Manufacturers' Association, found that the most commonly cited reason for smoking was as a means of alleviating stress, followed by social considerations, as a way to relieve boredom, out of routine or habit, as a way of signalling a few personal moments of 'time out', and addiction. There was also a close connection between smoking and other social behaviours such as drinking alcohol, gambling, or having a cup of tea or coffee.6, 112 Smoking was also seen as an aid to weight loss (sometimes, ironically, in response to health advice to reduce weight due to other medical conditions such as diabetes or heart disease).6 One group interviewed reported that smoking was used as a way of curbing appetite, because they did not feel like cooking, or because there was no money for food.6 The Forgotten Smokers adds that respondents liked and valued smoking because unlike anything else in their lives, it reliably produced a relaxing and calming effect.112

Apart from health considerations, negative aspects commonly reported about tobacco use were objections to the smell of the smoke (mainly from women) and the financial cost of buying cigarettes.112

8.9.2 Awareness of the health effects of smoking and secondhand smoke

Recent research has shown that Aboriginal and Torres Strait Islander communities generally have a good understanding of the health problems associated with smoking. National research undertaken by the NATSITCP6 during 2001 found that more than 90% of respondents agreed that smoking was dangerous to health, and caused a range of illnesses, including lung cancer, heart disease, emphysema and asthma, stroke and blood flow problems, blood pressure problems and problems in pregnancy. Knowledge was lower about the dangers of developing oral cancers and complications in diabetics. However while 75% of respondents agreed that smoking was a big health problem,6 it was nonetheless relegated as a priority behind other health issues such as alcohol or illicit drugs, which present as a more immediate problem, both at community6, 36 and service level.6 The NATSITCP report points out, however, that a good understanding of the health dangers of smoking does not necessarily translate into quitting behaviour.6 Widespread self-exemption through a 'she'll be right' attitude, coupled with the long latency period for many of the diseases caused by smoking, also affect attitudes to quitting.112

There was also a high awareness of the fact that secondhand smoke is dangerous to health, although communities gave mixed reports about whether it had instigated behavioural change.6 Levels of awareness were likely to be higher among those employed in workplaces which had introduced smokefree policies, but this only influenced those in employment. Given the high smoking rates among Indigenous people, it is probable that secondhand smoke is a serious contributor to ill health, especially for children.

8.9.3 The perception of tobacco as a 'lesser evil'

The NATSITCP report found that compared to other drugs such as alcohol, cannabis and intravenous drug use, tobacco smoking was of much lesser concern, and some individuals expressed the view that smoking was an acceptable alternative to other drug use.6 Other studies have also shown that tobacco is ranked behind alcohol and other drugs in order of priority by Indigenous communities.36, 38, 112, 114

8.9.4 Barriers to quitting

Many of the factors which motivate or maintain smoking behaviour, in turn become deterrents to quitting. The role of tobacco use in alleviating stress and negative feelings gives it value in communities experiencing high levels of daily hardship. Where smoking is commonplace, it serves as a way of identifying oneself with the group and enhancing social interactions. The special cultural connotations of tobacco use for Aboriginal and Torres Strait Islander communities strongly reinforce the behaviour. Within this setting, quit attempts are often undermined by others in the group6, 36, 112 and abstinence can result in a sense of exclusion. Although there is evidence that many Indigenous people would like to quit, and have attempted to do so (see Section 8.6 ), there is also a common belief that quitting is very difficult.6, 36 One report studying Indigenous perceptions of smoking behaviour found that most individuals surveyed did not know anyone who had successfully quit smoking.112 Other smokers who have quit and relapsed may express fatalism—that quitting is just too hard.6, 57

The perception that tobacco smoking is not a high priority as a health concern also serves as a disincentive to quit. As noted above, the pervasive view held by many individuals and health workers that other health issues such as alcohol abuse or the use of illicit drugs are of more immediate concern deflects attention from tobacco.6, 36 Additionally, those wishing to give up smoking may not be adequately supported by health services. Half of the health staff interviewed for the NATSITCP reported that they had received no specific tobacco-related training. Fewer than half of the health staff interviewed (43%) had discussed smoking with their clients. Those who had not discussed smoking cited lack of training, time and resources, and 'not feeling comfortable' doing so as reasons for avoiding the issue.6 A study of health workers in the south coast region of New South Wales reports similar deterrents to providing cessation advice.58

Interestingly, the NATSITCP found that respondents tended to overestimate the prevalence of smoking in their communities. Given that the perception of high levels of smoking behaviour is seen as an impediment to quitting,6, 36 there may be value in informing communities of the true prevalence of smoking, and that a significant number of Aboriginal peoples and Torres Strait Islanders choose not to smoke.6 Other recommendations supporting quitting activities are discussed in the following Section.