Community action for smoking cessation in remote Aboriginal communities

在过去的30年里，澳大利亚的吸烟率减半，2004年降至20%以下。然而，澳大利亚土著居民的吸烟率是这个数字的两倍多。在北部偏远的“高端”土著社区，超过三分之二的人口吸烟。一般来说，吸烟是澳大利亚人最大的疾病负担。对澳大利亚土著居民来说，这是发病率和过早死亡的最重要的可逆风险因素。由于没有减少吸烟水平的迹象，澳大利亚土著居民因许多与烟草有关的疾病住院或死亡的风险仍然较大。澳大利亚通过个人导向的措施、公众教育和供应控制减少了吸烟。这些策略要么没有在土著社区试用过，要么没有得到充分的研究。有效的干预措施可为澳大利亚土著居民带来重大健康收益，并降低保健费用。我们提出的干预措施将基于一项协议，即“高端”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。在这些孤立的小地方，整个社区的烟草销售是一个敏感和可靠的措施，如果干预有效，应该会下降。在每个社区进行干预前将对吸烟者进行评估，并随访两次以评估戒烟率。戒烟率应该上升。这项研究需要5年的时间，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。通过交错实施干预措施，即不是一次在所有社区开始，在多个社区减少吸烟将使我们相信干预措施是有效的。

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.