Community action for smoking cessation in remote Aboriginal communities

澳大利亚的吸烟率在过去30年里下降了一半，2004年降至20%以下。然而，澳大利亚土著居民的吸烟率仍然是这个数字的两倍以上。在新界“高端”的偏远原住民社区，超过三分之二的人口吸烟。吸烟通常会给澳大利亚人带来最大的疾病负担。对于土著澳大利亚人来说，它是发病率和过早死亡的唯一最重要的可逆风险因素。由于吸烟水平没有下降的迹象，澳大利亚土著居民住院或死于许多与烟草有关的疾病的风险仍然更大。澳大利亚通过以个人为导向的措施、公共教育和供应控制减少了吸烟。这些战略要么没有尝试过，要么在土著社区中没有得到充分的研究。有效的干预措施可以为澳大利亚原住民带来重大的健康收益，并降低医疗成本。我们提议的干预措施将基于一项协议，根据该协议，“高端”地区的四个偏远社区将与研究人员达成协议，共同努力通过社区范围的动员、培训和教育来减少吸烟。干预具有多个组成部分。我们不会单独评估每个组件。将评估整个干预措施对吸烟的影响。在这些与世隔绝的小地方，整个社区的烟草销售是一项敏感而可靠的衡量标准，如果干预措施奏效，应该会下降。在每个社区的干预之前，将对吸烟者进行评估，并进行两次跟踪，以评估戒烟率。戒烟率应该会上升。这项研究需要五年时间，因为吸烟行为的改变不会很快发生，也不会在人们第一次尝试时发生。随着干预措施的交错实施，即不是在所有社区同时开始，不止一个社区的吸烟减少将使我们相信干预措施有效。

Smoking rates halved in Australia over the past 30 years to below 20% in 2004. However, Indigenous Australians continued to smoke at more than double this rate. In remote Aboriginal communities in the NT's 'Top End', over two-thirds of the population smoke. Smoking tobacco causes the greatest burden of disease for Australians generally. For Indigenous Australians, it is the single most important reversible risk factor for morbidity and premature mortality. With no sign of reduction in smoking levels, Indigenous Australians remain at greater risk of hospitalisations or death from many tobacco-related illnesses. Smoking in Australia was reduced through individually-oriented measures, public education and supply control. These strategies have either not been tried or have not been adequately studied in Aboriginal communities. Effective interventions could provide major health gains for Aboriginal Australians and reduce health costs. The intervention we propose will be based on an agreement whereby four remote communities in the 'Top End' will make a pact with the researchers to jointly try to reduce tobacco smoking using community-wide mobilisation, training and education. The intervention with have multiple components. We will not evaluate each component separately. The effect of the whole intervention on smoking will be assessed. Tobacco sales for the whole community in these small isolated localities, a sensitive and reliable measure, should decline if the intervention works. Tobacco smokers will be assessed before the intervention in each community and followed up twice to assess quit rates. Quit rates should go up. Five years are needed for the study because smoking behaviour change does not happen quickly or at peoples' first attempt. With staggered implementation of the intervention, i.e. not starting in all communities at once, reductions in smoking in more than one community will make us confident that the intervention worked.