Community action for smoking cessation in remote Aboriginal communities

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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.