1. Smoking among Indigenous Australians
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

2. 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.

3. What we will cover today?
Background – smoking
The Smoke Ring study
Preliminary findings
No More Boondah
Conclusions

4. Chronic disease risk factors - 2010
ADD NOTES HERE

5. Indigenous tobacco control initiative commenced
March 2008
Quitline enhancement

6. Aboriginal and Torres Strait Islander smoking story
Source: ABS Aboriginal and Torres Strait Islander Health Survey
*Data for non-Indigenous people are for , from the Australian Health Survey

7. Aunty Lorraine Webb
Wiradjuri & Ngunnawal woman from Cowra, NSW, Australia.

8. 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 aim of the research is to contribute to the evidence-base on tobacco control interventions targeting the Indigenous Australian population in the Australian Capital Territory (ACT), with a core component investigating networks and the influence in relation to shifting tobacco use, behaviours and attitudes. The project will focus on evaluating tobacco control interventions, including the No More Boondah which has been running in the ACT since xxxx and will help inform ACT Aboriginal and Torres Strait Islander Tobacco Control strategy.

9. The sample Survey Key informant interviews Focus groups participants
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%
Male (%)
35%
40%
≈50%
Female (%)
65%
60%
Mean age
35.2 years
Not collected
Age range
12 to 75 years
≈20 to ≈60 years
12 to ≈ 60 years
Pregnant (%)
30%
Median household income from all sources
$67,600-$83,199 p/a ($1,300-$1,599/week)
Median household size
2 people
Household size range
1 – 7 people
Indigenous participants:
Yr 12 completed (%)
47%
The aim of the research is to contribute to the evidence-base on tobacco control interventions targeting the Indigenous Australian population in the Australian Capital Territory (ACT), with a core component investigating networks and the influence in relation to shifting tobacco use, behaviours and attitudes. The project will focus on evaluating tobacco control interventions, including the No More Boondah which has been running in the ACT since xxxx and will help inform ACT Aboriginal and Torres Strait Islander Tobacco Control strategy.

10. 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

11. Preliminary analysis The model contained 10 independent variables:
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.

12. Preliminary analysis: Log Regression
The model was statistically significant χ2 (5, N = 49) = , p < .001, indicating that the model could distinguish between smoking and non-smoking 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

13. Variables in the Equation
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 family smoking status
2.064
1.242
2.762
.097
7.875
.691
89.795
Year 12 or equivalent
3.068
1.020
9.051
.003
21.502
Unemployed
.462
1.360
.115
.734
1.587
.110
22.822
Gender
-1.911
1.224
2.436
.119
.148
.013
1.630
Attended a cultural event in the last 12 months
-.471
1.145
.169
.681
.624
.066
5.888
Household income
-.951
.954
.994
.319
.386
.060
2.506
Number of friends that smoke
-.724
.513
1.997
.158
.485
.177
1.323
Proportion of friends that smoke
-.115
1.297
.008
.930
.892
.070
11.336
Proportion of housemates that smoke
2.466
1.234
3.995
.046
11.776
1.049
Constant
-1.921
1.182
2.641
.104
.146

14. Social Network Analysis
Total network
Smokers
Non-smokers
Nodes
871
257
456
Number of ties
1368
181
255
Gender
Males (%)
40.7
38.3
44.3
Females (%)
59.3
61.7
55.7
Age
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
Average Path Length
10.993
2.805
2.678
APL - Natural Log n
6.770
5.549
6.122
Clustering coefficient
Overall graph clustering coefficient
0.022
0.057
0.008
Weighted Overall graph clustering coefficient
0.025
0.034
0.002

15. Total network by smoking status, gender and ties

17. Smoking network by gender and ties
Smokers

18. Non-smoking network by gender and ties

19. Average: smoker vs non-smoker

20. 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…”

21. 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

22. No More Boondah Phone and group support Outreach and education
Facilitates access to pharmacotherapy
Transport to attend weekly group
Trained tobacco workers

23. 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

24. “Evidence builds confidence and confidence inspires commitment”
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”

25. Acknowledgements This research is funded by the ACT Government
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