Browsing by Author "Thomas D.P."
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Item Aboriginal and Torres Strait Islander smoke-free homes, 2002 to 2008.(2015-11-16) Thomas D.P.; Stevens M.Objective: To describe the social patterning of and trends in the prevalence of Aboriginal and Torres Strait Islander smoke-free homes, and the association between these smoke-free homes and smoking initiation, intensity and cessation. Methods: Analyses of responses to questions about whether any householders usually smoke inside in the 2004 National Aboriginal and Torres Strait Islander Health Survey, the 2008 National Aboriginal and Torres Strait Islander Social Survey, and in the comparable National Health Surveys in 2004 and 2007. Results: The proportion of Indigenous children living with at least one daily smoker who smokes inside declined significantly from 28.4% in 2004 to 20.8% in 2008, with significant improvements only detected among the most disadvantaged categories of Indigenous children. The proportion of Indigenous daily smokers who lived in multi-person households where no daily smoker householder usually smoked inside increased significantly from 45.0% in 2004 to 56.3% in 2008. The absolute size of these changes was greater among Indigenous children and smokers than among all Australians. More disadvantaged Indigenous children were more likely to be exposed to secondhand smoke at home, and more disadvantaged Indigenous smokers were more likely to live in households where smokers usually smoked inside. Indigenous smokers in smoke-free homes smoke significantly less cigarettes. Conclusions: The increases in Indigenous smoke-free homes are encouraging, especially as they are from the period before recent increased attention to Indigenous tobacco control, which should accelerate these trends and their resultant health benefits for Aboriginal and Torres Strait Islander children and families.Copyright © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.Item Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994-2008.(2013-03-05) Thomas D.P.To describe smoking intensity among Indigenous Australians and any changes that occurred between 1994 and 2008. Analysis of data from two national cross-sectional household surveys conducted among Aboriginal and Torres Strait Islander people--the 1994 National Aboriginal and Torres Strait Islander Survey, and the 2008 National Aboriginal and Torres Strait Islander Social Survey, with 8565 and 7803 respondents aged 15 years and over, respectively. Self-reported number of cigarettes per day (CPD) smoked. In 2008, the mean number of CPD smoked by Indigenous smokers was 14.8 (95% CI, 14.1-15.4 CPD). The age-standardised proportion of Indigenous people who smoked more than 20 CPD declined from 17.3% in 1994 (95% CI, 15.8%-18.7%) to 9.4% in 2008 (95% CI, 8.4%-10.5%), a 45% relative reduction. The proportion of respondents who smoked 1-10 CPD increased from 16.8% (95% CI, 15.1%-18.5%) to 21.6% (95% CI, 20.1%-23.2%). Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.Item Factors influencing smoking among Indigenous adolescents aged 10-24 years living in Australia, New Zealand, Canada, and the United States: a systematic review.(2021-05-11) Heris C.L.; Chamberlain C.; Gubhaju L.; Thomas D.P.; Eades S.J.Introduction: Smoking rates are higher among Indigenous populations in most high-income countries with initiation primarily occurring in adolescence for all population groups. This review aims to identify protective and risk factors for smoking behavior among Indigenous adolescents and young adults. Aims and Methods: We searched Medline, Embase, and Psychinfo for all original research published between January 2006 and December 2016 that reported influences on smoking for Indigenous adolescents or young adults aged 10-24 living in Australia, New Zealand, Canada, and the United States (US). Extracted data were coded to individual, social, and environmental level categories using a modified Theory of Triadic Influence framework. Result(s): A total of 55 studies were included, 41 were descriptive quantitative and 14 qualitative, and 26 included Indigenous participants only. The majority were from the US (32). Frequently reported influences were at the individual and social levels such as increasing age; attitudes and knowledge; substance use; peer and family relationships; smoking norms; mental health; physical activity. At the environmental level, smoke-free spaces; second-hand smoke exposure; high community level prevalence; and social marketing campaigns were also frequently reported. Some studies referenced price, access, and traditional tobacco use. Few reported historical and cultural factors. Conclusion(s): Young Indigenous people experience similar influences to other populations such as smoking among family and friends. Greater youth smoking is related to broader community level prevalence, but few studies explore the distal or historical contributing factors such as traditional tobacco use, colonization, experiences of intergenerational trauma and discrimination, or the role of cultural connection. Implications: This review identified a range of factors that influence Indigenous youth smoking and contributes to an understanding of what prevention measures may be effective. Youth tobacco use occurs alongside other substance use and may also serve as an indicator of mental health. Comprehensive community-based programs that work more broadly to address the risk factors related to tobacco, including improving youth mental health, will be important for other behaviors as well. This research highlights the importance of social influence and need for ongoing denormalization of smoking. Future Indigenous led and community owned research is needed to identify likely protective cultural factors.Copyright © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.Item From the Lowitja Institute: maximising the impact of Aboriginal and Torres Strait Islander health research.(2012-09-24) Thomas D.P.; Brodie L.Item Impact and perceptions of tobacco tax increase in remote Australian Aboriginal communities.(2013-05-27) Thomas D.P.; Ferguson M.; Johnston V.; Brimblecombe J.Introduction: We sought to assess the impact of a 25% tax excise rise on tobacco sales in Aboriginal communities in remote Australia and to explore local perceptions about tobacco tax rises and their impact. Method(s): Tobacco sales data were collected from 18 stores in small remote Aboriginal communities from October 2009 to December 2010. Sales in the 7 months before and after the tax increase were compared. Interviews were conducted with 54 informants in 6 communities. Result(s): There was a nonsignificant 2.2% average reduction (95% CI = -5 to 10) in total tobacco sold in a store in the 7 months after the price increase compared with the 7 months before the price increase, with a large variation across the 18 stores. The magnitude of this apparent impact may have been reduced by seasonal effects. There were increased demands to share cigarettes, with a perception that there was increased reliance on those with more disposable income to purchase cigarettes for other smokers. The main reasons given for not quitting or reducing smoking were dependence, the normative nature of smoking, and the lack of support to quit. All Aboriginal interviewees supported price increases as important in reducing smoking. Conclusion(s): The wide confidence interval around our estimated reduction in consumption means that the tax increase could have either been associated or not with a reduction in consumption. Future excise rises are supported but should be carefully monitored in Australian Indigenous populations. © The Author 2012. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.Item In reply.(2013-06-07) Thomas D.P.Item Indigenous participation in an informal national Indigenous health policy network.(2011-10-04) Lock M.J.; Thomas D.P.; Anderson I.P.; Pattison P.Objective. To determine and describe the features of Indigenous participation in an informal national Indigenous health policy network. Design. A questionnaire was administered during 200304. Through a snowball nomination process a total of 227 influential persons were identified. Of these, 173 received surveys of which 44 were returned, a return rate of 25%. Outcome measures. These data were analysed to detect the existence of network groups; measure the degree of group interconnectivity; and measure the characteristics of bonds between influential persons. Demographic information was used to characterise the network and its groups. Results. Indigenous people were integral to the network due to their high representation, their distribution throughout the 16 groups, and the interconnections between the groups. The network was demographically diverse and multiple relational variables were needed to characterise it. Indigenous and non-Indigenous people had strong ties in this network. Conclusion. Social network methods made visible an informal network where Indigenous and non-Indigenous people relate in a complex socio-political environment to influence national Indigenous health policy. What is known about the topic? The participation of Indigenous people is acknowledged as important in health, but there is criticism of the lack of real opportunities for Indigenous people to participate in national Indigenous health policy processes. What does this paper add? This research reveals the presence of an informal network of influential persons. It demonstrates a way to investigate the concept of participation through social network analytic techniques. It reveals that Indigenous people are fundamental to an informal network that influences national health policy processes. What are the implications for practitioners? Practitioners can become more aware of their place in informal networks of influence and of their capacity to exercise personal influence in national policy decisions based on advice drawn from their informal networks. © 2011 AHHA.Item Maternal smoking and smoking in the household during pregnancy and postpartum: findings from an Indigenous cohort in the Northern Territory.(2011-06-16) Johnston V.; Thomas D.P.; McDonnell J.; Andrews R.M.Objective: To describe the trends in maternal smoking and smoking in the household for a cohort of Indigenous women followed from late pregnancy to 7 months postpartum. Design and setting: Prospective cohort study embedded within a randomised controlled trial (RCT) performed in the Northern Territory involving participants recruited between 30 June 2006 and 4 May 2010. Participant(s): 215 Indigenous women aged 17-39 years who had been recruited into the RCT, 162 of whom had completed their last study visit at 7 months postpartum by 1 June 2010. Main Outcome Measure(s): Smoking status of women, and smoking within their households, in their third trimester, and at 1 month, 2 months and 7 months postpartum. Result(s): There were complete data on women's smoking status for 121 participants. Among these, the self-reported smoking rate was 45% (95% CI, 36%-55%) during pregnancy, increasing to 63% (95% CI, 54%-71%) at 7 months postpartum. Of the 66 women who were non-smokers at the antenatal visit, 23 (35%; 95% CI, 23%-47%) were smoking by the time their baby reached 7 months of age. Thirty-one per cent (95% CI, 23%-39%) of households included people who smoked inside during the antepartum period, whereas 16% (95% CI, 10%-23%) included people who smoked inside at 7 months postpartum. Conclusion(s): While an apparent reduction in indoor exposure to tobacco smoke during the postpartum period is encouraging, this is offset by an increase in the proportion of antenatal non-smokers who subsequently reported smoking after the birth of their child. More health care service delivery and research attention needs to be directed to smoking during pregnancy and to postpartum relapse in this population.Item Reducing smoking among Indigenous populations: new evidence from a review of trials.(2013-08-05) Johnston V.; Westphal D.W.; Glover M.; Thomas D.P.; Segan C.; Walker N.Introduction: Previous reviews have concluded that to be effective, evidence-based tobacco control interventions should be culturally adapted to Indigenous populations. We undertook a systematic review to critically examine this hitherto conclusion. Method(s): We searched MEDLINE, PsychInfo, EMBASE, and Cochrane databases from 1980 to May 2012 for controlled trials. We included studies that recruited nonIndigenous and Indigenous participants to assess differences in impact of nonadapted interventions across ethnic groups and whether adapted interventions are more effective for Indigenous participants. Result(s): Five studies were included. Three tested the effectiveness of enhanced Quitline protocols with cessation products over usual Quitline care, and two trialed a culturally adapted cessation counseling intervention using mobile phones. Three studies did not demonstrate a significant effect of the intervention for both Indigenous and nonIndigenous participants; two were pharmacotherapy studies using nicotine replacement therapy and the third was a trial of a multimedia phone intervention. The fourth study found a significant effect of a behavioral intervention using text messaging for Indigenous and nonIndigenous participants. The final study found a significant effect in favor of very low nicotine cigarettes compared with usual care; results were similar across ethnic groups. Discussion(s): There is likely no significant difference between Indigenous and nonIndigenous populations regarding the efficacy of smoking cessation products, and we provide some promising evidence on the efficacy of behavioral interventions delivered via mobile phone technology. We demonstrate that not all tobacco control interventions can or necessarily need to be culturally adapted for Indigenous populations although there are circumstances when this is important. © The Author 2013. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.Item Smoking and Aboriginal and Torres Strait Islander and Maori children.(2010-10-08) Thomas D.P.; Glover M.Smoking and the deaths and suffering it causes are more common among Aboriginal and Torres Strait Islander peoples and Maori than other Australians and New Zealanders. While, many tobacco control activities that are not specifically targeted at children will have a positive impact on child health, this review concentrates on recent tobacco control research on pregnant women and children. The important tasks are to reduce smoking by pregnant Maori and Aboriginal and Torres Strait Islander women to reduce infant and child exposure to second-hand smoke and to reduce smoking initiation of children and adolescents. Health professionals who want to reduce the suffering caused by smoking among Maori and Aboriginal and Torres Strait Islander children can be guided by much new relevant research evidence and clear frameworks about how to approach tobacco control in these communities. © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).Item Smoking behaviours in a remote Australian Indigenous community: the influence of family and other factors.(2008-11-24) Johnston V.; Thomas D.P.In Australia, tobacco smoking is more than twice as common among Indigenous people as non-Indigenous people. Some of the highest smoking rates in the country are in remote Indigenous communities in the Northern Territory of Australia. Owing to this high prevalence, tobacco use today is the single biggest contributing risk factor for excess morbidity and mortality among Indigenous Australians. Despite this, there is a lack of published research which qualitatively explores the social context of Indigenous smoking behaviour or of meanings and perceptions of smoking among Indigenous people. The aim of this study was to understand why Indigenous people start to smoke, the reasons why they persist in smoking and the obstacles and drivers of quitting. We conducted semi-structured interviews with a purposive sample of 25 Indigenous community members in two remote communities in the Northern Territory and 13 health staff. The results indicate that there is a complex interplay of historical, social, cultural, psychological and physiological factors which influence the smoking behaviours of Indigenous adults in these communities. In particular, the results signal the importance of the family and kin relations in determining smoking behaviours. While most community participants were influenced by family to initiate and continue to smoke, the health and well being of the family was also cited as a key driver of quit attempts. The results highlight the importance of attending to social and cultural context when designing tobacco control programs for this population. Specifically, this research supports the development of family-centred tobacco control interventions alongside wider policy initiatives to counter the normalisation of smoking and assist individuals to quit. © 2008 Elsevier Ltd. All rights reserved.Item Starting to smoke: a qualitative study of the experiences of Australian Indigenous youth.(2013-01-23) Johnston V.; Westphal D.W.; Earnshaw C.; Thomas D.P.Background: Adult smoking has its roots in adolescence. If individuals do not initiate smoking during this period it is unlikely they ever will. In high income countries, smoking rates among Indigenous youth are disproportionately high. However, despite a wealth of literature in other populations, there is less evidence on the determinants of smoking initiation among Indigenous youth. The aim of this study was to explore the determinants of smoking among Australian Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group. Methods. This project was undertaken in northern Australia. We undertook group interviews with 65 participants and individual in-depth interviews with 11 youth aged 13-20 years led by trained youth 'peer researchers.' We also used visual methods (photo-elicitation) with individual interviewees to investigate the social context in which young people do or do not smoke. Included in the sample were a smaller number of non-Indigenous youth to explore any significant differences between ethnic groups in determinants of early smoking experiences. The theory of triadic influence, an ecological model of health behaviour, was used as an organising theory for analysis. Result(s): Family and peer influences play a central role in smoking uptake among Indigenous youth. Social influences to smoke are similar between Indigenous and non-Indigenous youth but are more pervasive (especially in the family domain) among Indigenous youth. While Indigenous youth report high levels of exposure to smoking role models and smoking socialisation practices among their family and social networks, this study provides some indication of a progressive denormalisation of smoking among some Indigenous youth. Conclusion(s): Future initiatives aimed at preventing smoking uptake in this population need to focus on changing social normative beliefs around smoking, both at a population level and within young peoples' immediate social environment. Such interventions could be effectively delivered in both the school and family environments. Specifically, health practitioners in contact with Indigenous families should be promoting smoke free homes and other anti-smoking socialisation behaviours. © 2012 Johnston et al.; licensee BioMed Central Ltd.Item The social determinants and starting and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers.(2017-12-21) Thomas D.P.; Panaretto K.S.; Davey M.; Briggs V.; Borland R.Objective: To assess whether social, economic and demographic measures are associated with initiating and sustaining quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers. METHODS: We analysed data from 759 adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012 - October 2013) and completed a follow up survey a year later (August 2013 - August 2014). Results: Almost none of the standard baseline socioeconomic indicators predicted making or sustaining quit attempts. However, becoming employed was associated with making quit attempts (OR 1.88) and both becoming employed (OR 3.03) and moving to purchase a home (OR 2.34) were both positively associated with sustaining abstinence of one month or more. More smokers who had insufficient money for food or essentials because of money spent on cigarettes had made a quit attempt (OR 1.47) and sustained abstinence of one month or more (OR 1.74). CONCLUSIONS AND IMPLICATIONS: Disadvantage does not seem to have pervasive negative effects on quitting. We should be more optimistic in our tobacco control activities with the most disadvantaged among Aboriginal and Torres Strait Islander smokers. Increasing personal empowerment (e.g. getting a job) may lead to at least short-term improvements in quitting.Copyright © 2017 Public Health Association of Australia.Item The tobacco industry and Aboriginal and Torres Strait Islander people.(2012-09-24) Thomas D.P.; Bond L.Item Wholesale data for surveillance of Australian Aboriginal tobacco consumption in the Northern Territory.(2011-11-03) Thomas D.P.; Fitz J.W.; Johnston V.; Townsend J.; Kneebone W.Objectives Effective monitoring of trends in tobacco use is an essential element of tobacco control policy. Monitoring tobacco consumption using tobacco wholesale data has advantages over other methods of surveillance. In the present work, a research project that monitored tobacco consumption in 25 remote Aboriginal communities and its translation to a policy to implement this monitoring routinely in the entire Northern Territory of Australia is described. Methods Tobacco consumption and trends were estimated using wholesale (or occasionally sales) data from all retail outlets in 25 remote Aboriginal communities. Self-reported consumption was estimated from the National Aboriginal and Torres Strait Islander Social Survey in 2008. Local consumption results were fed back in posters to local organisations and health staff. Results Estimates of consumption from wholesale data and self-report were similar (6.8 and 6.7 cigarettes/day/person aged 15 and over). Consumption was higher in the tropical Top End than in arid Central Australia, and 24% of tobacco was consumed as loose tobacco. The overall trend in monthly consumption was not significantly different from 0. Local communities could be ranked by their local trends in monthly consumption. Conclusions Monitoring tobacco consumption using wholesale tobacco data is a practical and unobtrusive surveillance method that is being introduced as a new condition of tobacco retail licenses in the Northern Territory of Australia. It overcomes some problems with consumption estimates from routine surveys, enables rapid feedback and use of results and is particularly well suited for hard-to-reach discrete populations, such as remote Aboriginal communities in Australia. It has already been used to evaluate the impact of local tobacco control activities.