Australian urban Indigenous smokers' perspectives on nicotine products and tobacco harm reduction.

INTRODUCTION AND AIMS: Indigenous Australians experience a significant gap in life expectancy compared with non-Indigenous Australians. Indigenous communities have high-smoking prevalence and low engagement with cessation therapies. This qualitative research, conducted in an urban Australian Indigenous community, explored smokers' views on smoking, quitting and engagement with current nicotine replacement therapies. Opinions on acceptability of tobacco harm reduction were sought. We explored the acceptability of novel nicotine products, that is, new or unfamiliar products, including non-therapeutic options, such as e-cigarettes. DESIGN AND METHODS: Focus groups and individual interviews with adult Indigenous daily smokers (n = 27) were used. Current and novel nicotine products were displayed and demonstrated. Discussions were audio-recorded, transcribed and analysed thematically. RESULTS: Participants expressed interest in trying existing and novel nicotine products. Short-to-medium term use of nicotine replacement therapy for quitting was generally acceptable; views on long-term use were mixed. Interest in use of tobacco substitutes depended on their perceived effectiveness, providing a 'kick' and 'relieving stress'. Desirable qualities for tobacco substitutes were identified with gender differences and product preferences noted. The unpleasant taste of existing products is a barrier to both short-term and long-term use. DISCUSSION: We found substantial interest in trying some existing and novel nicotine products, mostly for short-term use. A number of attributes were identified that would make nicotine products potentially acceptable as a long-term substitute. CONCLUSIONS: Some participants were interested in long-term substitution if acceptable products were available. Improvements in current products and access to novel products are needed if tobacco harm reduction is to be acceptable. [Yuke K, Ford P, Foley W, Mutch A, Fitzgerald L, Gartner C. Australian urban Indigenous smokers' perspectives on nicotine products and tobacco harm reduction. Drug Alcohol Rev 2018;37:87-96].

Stuck in the catch 22: attitudes towards smoking cessation among populations vulnerable to social disadvantage.

AIM: To explore how smoking and smoking cessation is perceived within the context of disadvantage, across a broad cross-section of defined populations vulnerable to social disadvantage. DESIGN: Qualitative focus groups with participants recruited through community service organizations (CSO). SETTING: Metropolitan and regional settings in Queensland, Australia. Focus groups were held at the respective CSO facilities. PARTICIPANTS: Fifty-six participants across nine focus groups, including people living with mental illness, people experiencing or at risk of homelessness (adult and youth populations), people living with HIV, people living in a low-income area and Indigenous Australians. MEASUREMENTS: Thematic, in-depth analysis of focus group discussions. Participant demographic information and smoking history was recorded. FINDINGS: Smoking behaviour, smoking identity and feelings about smoking were reflective of individual circumstances and social and environmental context. Participants felt 'trapped' in smoking because they felt unable to control the stressful life circumstances that triggered and sustained their smoking. Smoking cessation was viewed as an individual's responsibility, which was at odds with participants' statements about the broader factors outside of their own control that were responsible for their smoking. CONCLUSION: Highly disadvantaged smokers' views on smoking involve contradictions between feeling that smoking cessation involves personal responsibility, while at the same time feeling trapped by stressful life circumstances. Tobacco control programmes aiming to reduce smoking among disadvantaged groups are unlikely to be successful unless the complex interplay of social factors is carefully considered.