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RESEARCH showing a substantial decline in heavy smoking among Indigenous Australians over a 14-year period has been cautiously welcomed.
The research, published in the MJA, found a 45% relative reduction in the proportion of Indigenous people who smoked more than 20 cigarettes a day, dropping from 17.3% in 1994 to 9.4% in 2008. The research noted a corresponding increase in light smoking with 21.6% of respondents saying they smoked 1–10 cigarettes a day in 2008, compared to 16.8% in 1994. (1)
Professor Sandra Eades, professor of public health at the University of Sydney, said the findings were promising, but the 14-year gap between the two surveys, along with the fact that the smoking rates were self-reported, meant the research should be interpreted with caution.
The self-reporting of smoking rates was acknowledged in the research as a limitation.
Professor Eades said various studies had shown marginal reductions in smoking prevalence in Indigenous communities, including an unpublished WA study that found smoking in pregnancy among Indigenous women had dropped from 44.8% to 42.5%, indicating that the true underlying change was “moving in the right direction”.
The MJA research, conducted by Associate Professor David Thomas of the Menzies School of Health Research and the Lowitja Institute at Charles Darwin University, follows the publication of another study earlier this year that found a reduction in smoking prevalence in all Indigenous men and in Indigenous women in non-remote areas between 1994 and 2008, but an increase in smoking in Indigenous women in remote areas. (2)
However, the age-standardised prevalence of current smoking in Indigenous people aged over 18 years (49.8%) was still more than double that of other Australians (20.5%) in 2008. (3)
In the MJA study, Professor Thomas wrote that smoking caused greater damage at higher doses. “Reducing smoking intensity and prevalence will lead to reduced deaths and less illness due to smoking.”
He wrote that a drop in heavy smoking would also assist smoking cessation because smokers who smoked fewer cigarettes per day were more likely to attempt to quit smoking and be successful.
Associate Professor Rowena Ivers, of the University of Wollongong, said the MJA study findings were “fantastic news”.
“Of course, every cigarette does you damage, so smoking at any level can still cause damage, but heavier smoking causes more damage, so this is very good news”, said Dr Ivers, who also practises at the Illawarra Aboriginal Medical Service.
Dr Ivers said smoking was the major preventable contributor to the gap in life expectancy between Indigenous and other Australians. “Hopefully this reduction in intensity means in the long-term we will see a reduction in that gap in life expectancy and that is the overall aim.”
Professor Thomas wrote that the 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”.
He said changes in smoking habits may have been influenced by the mainstream National Tobacco Campaign (1997‒2005), increasing cigarette prices due to tax rises and reduced exposure to tobacco industry marketing.
However, Professor Eades said state-based programs and measures through Aboriginal community-controlled health services had been targeting Indigenous smokers for more than 20 years and may have also contributed to these changes.
She said there was a school of thought that mainstream programs were sufficient to address the high rates of smoking in Indigenous communities, but she believed programs targeting Indigenous smoking were necessary.
“Aboriginal people may exempt themselves from these [mainstream] messages, and that’s the good thing about the Commonwealth measures targeting Indigenous people”, Professor Eades said of the $100 million federal government campaign Tackling Indigenous Smoking.
– Nicole MacKee
1. MJA 2012; 197: 503-506
2. Aust NZ J Public Health 2012; 36: 24-29
3. AIHW 2011; Substance use among Aboriginal and Torres Strait Islander People
Posted 5 November 2012