8.6 Cessation

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8.0 Introductory note

8.1 Overview

8.2 History of tobacco use among Aboriginal peoples and Torres Strait Islanders

8.3 Prevalence of tobacco use among Aboriginal peoples and Torres Strait Islanders

8.4 Smoking among Aboriginal and Torres Strait Islander children and teenagers

8.5 Types of tobacco used by and levels of consumption among Aboriginal peoples and Torres Strait Islanders

8.6 Cessation

8.7 Morbidity and mortality caused by smoking among Aboriginal peoples and Torres Strait Islanders

8.8 Economic and social issues relating to tobacco use among Aboriginal peoples and Torres Straits Islanders

8.9 Attitudes to and beliefs about smoking

8.10 Interventions targeting Aboriginal peoples and Torres Straits Islanders

8.11 The relationship between tobacco and other drug use in Aboriginal and Torres Strait Islander communities

8.12 The tobacco industry and Indigenous communities

8.13 Policy recommendations for advancing tobacco control programs among Aboriginal peoples and Torres Strait Islanders

Acknowledgments

References

The most recent information on smoker status (including information on ex-smokers and never smokers) is reported in the National Aboriginal and Torres Strait Islander Health Survey, which also presents figures for the non-Indigenous population as a point of comparison (Table 8.7).35

Table 8.7 shows that for both sexes, in every age group, a lower proportion of Indigenous Australians have never smoked, compared to the rest of the Australian population. Indigenous Australians are also less likely to have quit smoking (be ex-smokers) than the non-Indigenous population, an exception being among women aged over 55. Overall, 52% of the Indigenous population smoke (including light smokers), 28% have never smoked, and 20% have quit.35 In the total Australian population, about 21% currently smoke (including light smokers), 53% have never smoked, and 26% have quit.82

The National Drug Strategy Household Survey Urban Aboriginal and Torres Strait Islander Supplement 1994 found that Indigenous smokers were more likely to have made an unsuccessful attempt at quitting than the rest of the population, were less likely to have switched to cigarettes with a lower tar/nicotine brand, and were less likely to have cut down on the amount smoked daily (Table 8.8).38

A number of smaller studies have focused on issues surrounding cessation in the Aboriginal and Torres Strait Islander populations. Findings from some of these are summarised here, but it should be noted that study sizes are small and not necessarily representative of the diversity within the Indigenous population. What can be drawn from them is the broad similarity between all Australians who smoke—many wish to quit and have made several attempts to do so, concerns for health are commonly held, and social context is a major influence on smoking behaviour.

Western Australian research on the smoking habits of urban Indigenous woman found that 49% of respondents smoked, 21% had quit and 30% had never smoked.77 Of those who had quit smoking, health concerns were cited as the main reason (49%), followed by pregnancy (12%). This study makes the point that one of the key functions of smoking in this subpopulation is its role as a facilitator of friendship bonding and social cohesiveness. This strongly reinforces smoking behaviour, and undermines likelihood of quitting, since to give up smoking is to risk social isolation and alienation.

The National Aboriginal and Torres Strait Islander Tobacco Control Project found that among smokers interviewed in its focus groups, 60% of smokers had made at least one quit attempt, and 11% had attempted to quit three or more times.6 Asked about behaviour modification in the past 12 months, 43% had tried unsuccessfully to quit, 21% had changed to tobacco with lower tar or nicotine content, and 25% were consuming less tobacco daily. Reasons most commonly given for returning to smoking after an attempt at quitting were succumbing to peer or family influences, stress and addiction. Male smokers were more likely to have changed their smoking behaviour than female smokers. Overall, 40% of smokers were thinking about quitting, 15% were actively trying to quit, and 27% had no intention to quit at that stage. Among those who had successfully quit smoking, the main motivators had been health, a personal wish to quit, cost, and family pressure. Those who stopped smoking on health grounds did so on medical advice, already having developed an illness. Quitters were more likely to have quit at a relatively early age (25 or younger). Half of quitters had done so 'cold turkey', suggesting that access to or acceptance of quit resources may be an area for future study.6

Research forming part of the evaluation for the National Tobacco Campaign examined the response to the campaign of metropolitan and rural dwelling Indigenous people in Victoria. The study found that intention to quit, and actual quit attempts, were lower than among the general population, despite generally good understanding of the health effects of smoking.36 Quitting was perceived as a very difficult goal, and with smoking being strongly embedded among community mores, peer expectation to smoke and the concomitant lack of social support for quitting combined to discourage quitting.

Attitudes and beliefs about smoking are discussed further in Section 8.9, and interventions and policies designed to promote and support quitting among Aboriginal peoples and Torres Straits Islanders are discussed in Sections 8.10 and 8.13 respectively. Smoking cessation is discussed in greater detail in Chapter 7.