Social networks and quitting in a national cohort of Australian Aboriginal and Torres Strait Islander smokers.

INTRODUCTION AND AIMS: Health behaviours, such as smoking and quitting, spread person-to-person through social networks. We explore how social networks are associated with making and sustaining quit attempts for at least 1 month among Aboriginal and Torres Strait Islander smokers. DESIGN AND METHODS: We analysed data from the nationally representative quota sample of 759 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in Talking About The Smokes baseline survey (April 2012-October 2013) who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: At baseline, 41% of smokers reported that all of their five closest family or friends smoked, but 62% reported that family or friends had provided encouragement to quit. Fewer smokers with other adult smokers in their household at baseline made a quit attempt between surveys (OR 0.63, 95% CI 0.45-0.87). Fewer smokers who had made an attempt between surveys sustained abstinence for at least 1 month if all of their five closest friends smoked (OR 0.60, 95% CI 0.37-0.97). Perceived support to quit in your social network was associated with making and sustaining a quit attempt. DISCUSSION AND CONCLUSIONS: Exposure to smoking in the social networks of Aboriginal and Torres Strait Islander smokers is an obstacle to quitting, but there is also considerable support for quitting from within these same social networks. Health staff could consider encouraging smokers to draw on the few non-smokers within their social networks as role models to increase their confidence in quitting.

Trends in the prevalence of hepatitis B infection among women giving birth in New South Wales.

OBJECTIVES: To evaluate the effect of targeted and catch-up hepatitis B virus (HBV) vaccination programs in New South Wales on HBV prevalence among women giving birth for the first time. DESIGN: Observational study linking data from the NSW Perinatal Data Collection for women giving birth during 2000-2012 with HBV notifications in the NSW Notifiable Conditions Information Management System. MAIN OUTCOME MEASURES: HBV prevalence in Indigenous Australian, non-Indigenous Australian-born, and overseas-born women giving birth. RESULTS: Of 482 944 women who gave birth to their first child, 3383 (0.70%) were linked to an HBV notification. HBV prevalence was 1.95% (95% CI, 1.88-2.02%) among overseas-born women, 0.79% (95% CI, 0.63-0.95%) among Indigenous Australian women, and 0.11% (95% CI, 0.09-0.12%) among non-Indigenous Australian-born women. In Indigenous Australian women, prevalence was significantly lower for those who had been eligible for inclusion in the targeted at-risk newborn or universal school-based vaccination programs (maternal year of birth, 1992-1999: 0.15%) than for those who were not (born ≤ 1981: 1.31%; for trend, P < 0.001). There was no statistically significant downward trend among non-Indigenous Australian-born or overseas-born women. HBV prevalence was higher among Indigenous women residing in regional and remote areas than those in major cities (adjusted odds ratio [aOR], 2.23; 95% CI, 1.40-3.57), but lower for non-Indigenous (aOR, 0.39; 95% CI, 0.28-0.55) and overseas-born women (aOR, 0.61; 95% CI, 0.49-0.77). CONCLUSION: Among women giving birth, there was a significant reduction in HBV prevalence in Indigenous women associated with the introduction of the HBV vaccination program in NSW, although prevalence remains higher than among non-Indigenous Australian-born women, and it also varies by region of residence. Continuing evaluation is needed to ensure that the prevalence of HBV infections continues to fall in Australia.

Talking About The Smokes: a large-scale, community-based participatory research project.

OBJECTIVE: To describe the Talking About The Smokes (TATS) project according to the World Health Organization guiding principles for conducting community-based participatory research (PR) involving indigenous peoples, to assist others planning large-scale PR projects. DESIGN, SETTING AND PARTICIPANTS: The TATS project was initiated in Australia in 2010 as part of the International Tobacco Control Policy Evaluation Project, and surveyed a representative sample of 2522 Aboriginal and Torres Strait Islander adults to assess the impact of tobacco control policies. The PR process of the TATS project, which aimed to build partnerships to create equitable conditions for knowledge production, was mapped and summarised onto a framework adapted from the WHO principles. MAIN OUTCOME MEASURES: Processes describing consultation and approval, partnerships and research agreements, communication, funding, ethics and consent, data and benefits of the research. RESULTS: The TATS project involved baseline and follow-up surveys conducted in 34 Aboriginal community-controlled health services and one Torres Strait community. Consistent with the WHO PR principles, the TATS project built on community priorities and strengths through strategic partnerships from project inception, and demonstrated the value of research agreements and trusting relationships to foster shared decision making, capacity building and a commitment to Indigenous data ownership. CONCLUSIONS: Community-based PR methodology, by definition, needs adaptation to local settings and priorities. The TATS project demonstrates that large-scale research can be participatory, with strong Indigenous community engagement and benefits.

Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians.

OBJECTIVE: To describe the research methods and baseline sample of the Talking About The Smokes (TATS) project. DESIGN: The TATS project is a collaboration between research institutions and Aboriginal community-controlled health services (ACCHSs) and their state and national representative bodies. It is one of the studies within the International Tobacco Control Policy Evaluation Project, enabling national and international comparisons. It includes a prospective longitudinal study of Aboriginal and Torres Strait Islander smokers and recent ex-smokers; a survey of non-smokers; repeated cross-sectional surveys of ACCHS staff; and descriptions of the tobacco policies and practices at the ACCHSs. Community members completed face-to-face surveys; staff completed surveys on paper or online. We compared potential biases and the distribution of variables common to the main community baseline sample and unweighted and weighted results of the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS). The baseline survey (Wave 1) was conducted between April 2012 and October 2013. SETTING AND PARTICIPANTS: 2522 Aboriginal and Torres Strait Islander people in 35 locations (the communities served by 34 ACCHSs and one community in the Torres Strait), and 645 staff in the ACCHSs. MAIN OUTCOME MEASURES: Sociodemographic and general health indicators, smoking status, number of cigarettes smoked per day and quit attempts. RESULTS: The main community baseline sample closely matched the distribution of the Aboriginal and Torres Strait Islander population in the weighted NATSISS by age, sex, jurisdiction and remoteness. There were inconsistent differences in some sociodemographic factors between our sample and the NATSISS: our sample had higher proportions of unemployed people, but also higher proportions who had completed Year 12 and who lived in more advantaged areas. In both surveys, similar percentages of smokers reported having attempted to quit in the past year, and daily smokers reported similar numbers of cigarettes smoked per day. CONCLUSION: The TATS project provides a detailed and nationally representative description of Aboriginal and Torres Strait Islander smoking behaviour, attitudes, knowledge and exposure to tobacco control activities and policies, and their association with quitting.

Tobacco control policies and activities in Aboriginal community-controlled health services.

OBJECTIVES: To describe tobacco control policies and activities at a nationally representative sample of Aboriginal community-controlled health services (ACCHSs). DESIGN, SETTING AND PARTICIPANTS: The Talking About The Smokes (TATS) project used a quota sampling design to recruit 34 ACCHSs around Australia. Between April 2012 and October 2013, a representative at each ACCHS completed a survey about the service's tobacco control policies and activities. Questions about support for smoke-free policies were also included in the TATS project survey of 2435 Aboriginal and Torres Strait Islander members of the communities served by the ACCHSs. MAIN OUTCOME MEASURES: ACCHS tobacco control policies and activities. RESULTS: Thirty-two surveys were completed, covering 34 sites. Most ACCHSs (24/32) prioritised tobacco control "a great deal" or "a fair amount", and all services had smoke-free workplace policies. Most had staff working on tobacco control and had provided tobacco control training within the past year. A range of quit-smoking information and activities had been provided for clients and the community, as well as extra smoking cessation support for staff. There was strong support for smoke-free ACCHSs from within the Aboriginal communities, with 87% of non-smokers, 85% of ex-smokers and 77% of daily smokers supporting a complete ban on smoking inside and around ACCHS buildings. CONCLUSIONS: The high level of commitment and experience within ACCHSs provides a strong base to sustain further tobacco control measures to reduce the very high smoking prevalence in Aboriginal and Torres Strait Islander populations.

Smoking cessation advice and non-pharmacological support in a national sample of Aboriginal and Torres Strait Islander smokers and ex-smokers.

OBJECTIVES: To describe recall among a national sample of Aboriginal and Torres Strait Islander smokers and recent ex-smokers of having received advice to quit smoking and referral to non-pharmacological cessation support from health professionals, and their association with quit attempts. DESIGN, SETTING AND PARTICIPANTS: The Talking About The Smokes project used a quota sampling design to recruit 1721 smokers and ex-smokers who had quit ≤ 12 months previously from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline surveys were conducted from April 2012 to October 2013. Results for daily smokers were compared with 1412 Australian daily smokers surveyed by the International Tobacco Control Policy Evaluation Project between 2006 and 2011. MAIN OUTCOME MEASURES: Participants' recall of having been: seen by a health professional in the past year, asked if they smoke, advised to quit, and referred to other cessation support services; and having made a quit attempt in the past year. RESULTS: Compared with other Australian daily smokers, higher proportions of Aboriginal and Torres Strait Islander daily smokers saw a health professional in the past year (76% v 68.1%) and were advised to quit smoking (75% v 56.2% of those seen). Most Aboriginal and Torres Strait daily smokers who saw a health professional recalled being asked if they smoke (93%). Aboriginal and Torres Strait Islander daily smokers who had been advised to quit were more likely to have made a quit attempt in the past year than those who had not (odds ratio, 2.00; 95% CI, 1.58-2.52). Among all Aboriginal and Torres Strait Islander smokers and recent ex-smokers who had been advised to quit, 49% were given a pamphlet or brochure on how to quit, but fewer were referred to the telephone Quitline (28%), a quit-smoking website (27%) or a local quit course, group or clinic (16%). CONCLUSION: Most Aboriginal and Torres Strait Islander daily smokers recalled being recently advised by a health professional to quit, which was associated with making a quit attempt.

Smoking among a national sample of Aboriginal and Torres Strait Islander health service staff.

OBJECTIVE: To examine smoking among Aboriginal and Torres Strait Islander staff of Aboriginal community-controlled health services (ACCHSs). DESIGN, SETTING AND PARTICIPANTS: The Talking About The Smokes (TATS) project surveyed 374 Aboriginal and Torres Strait Islander staff at a national sample of 31 ACCHSs, from April 2012 to October 2013. We made comparisons with adult participants in the 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and with 1643 smokers in a community sample of 2522 Aboriginal and Torres Strait Islander people also surveyed in the TATS project. MAIN OUTCOME MEASURES: Smoking status, smoking behaviour at work, quitting behaviour, attitudes and beliefs about smoking and quitting. RESULTS: Aboriginal and Torres Strait Islander ACCHS staff had a lower smoking prevalence than among all Aboriginal and Torres Strait Islander adults surveyed in the NATSISS (38% v 49.8%), but this difference was smaller when compared with only employed adults (38% v 44.8%). Staff smokers had higher odds than smokers in their communities of ever trying to quit (odds ratio [OR], 2.1; 95% CI, 1.1-3.7), of having often noticed anti-smoking advertising (OR, 2.8; 95% CI, 1.4-5.6), and of having used stop-smoking medications (OR, 3.0; 95% CI, 1.6-5.7), often with the support of their ACCHS. There was a significant association (P < 0.001) between the smoking status of Aboriginal and Torres Strait Islander staff and their confidence in talking to others about smoking and quitting; ex-smokers were most likely to report being confident. Most Aboriginal and Torres Strait Islander staff who smoked (74%) agreed that being a non-smoker sets a good example to patients at their health service, and most did not smoke with patients or at work where patients could see them. CONCLUSION: Smoking prevalence among Aboriginal and Torres Strait Islander ACCHS staff is only modestly lower than among other employed Aboriginal and Torres Strait Islander people. Given that ex-smokers feel more confident to help others quit than any other group, smoking cessation in ACCHS staff is a useful contributor to reducing community smoking rates.

Top end rural and remote Indigenous women: an Australian population group vulnerable to rubella.

Australian efforts to prevent cases of congenital rubella syndrome have been largely successful, although concerns that eradication has not yet been achieved are ongoing. This paper describes an Australian population group with a vulnerability to rubella which has not previously been reported. Fewer than 75 per cent of Indigenous women from rural and remote communities who gave birth at Royal Darwin Hospital in 1999 and were tested for rubella antenatally had adequate levels of immunity. By comparison Indigenous and non-Indigenous women living in the Darwin urban area had a prevalence of adequate immunity to rubella on antenatal testing of > 90 per cent, similar to estimates for other Australian-born population groups. Action is required to reduce the risk of cases of congenital rubella syndrome occurring in rural and remote Indigenous communities in the Top End, and may be needed in rural and remote settings elsewhere in Australia. Ensuring each child, adolescent and young adult has received two doses of Measles Mumps Rubella vaccine as part of their primary immunization course will provide increased protection. In addition, more women lacking adequate rubella immunity need to be vaccinated postnatally than was found in this study. Providers of women's care would be assisted in this task if laboratories adopted a standardized approach to reporting the results of antenatal rubella serology tests.

Nurse reporting of adverse events caused by medicines.

Even though all drugs are extensively tested before marketing, the need for continuous postmarketing surveillance is now greater than ever. In 2002, 16,176 adverse drug reaction reports were received, of which 67 per cent related to reactions categorised as 'serious'. Nurse reporting of adverse drug reactions has almost doubled in the past year since nurses were officially allowed to participate in the yellow-card scheme for identifying adverse drug reactions (NT Clinical news, 2 December, p7). Nurses, through their close contact with patients, are ideally placed to be a key source of information on adverse drug reactions in the UK's yellow-card scheme.

Can we better meet the healthcare needs of Aboriginal and Torres Strait Islander women?

Listening and responding to women will improve cervical screening and other women's health programs.

Are recommendations about routine antenatal care in Australia consistent and evidence-based?

OBJECTIVE: To describe the variability and evidence base of recommendations in Australian protocols and national policies about six aspects of routine antenatal care. DESIGN: Comparison of recommendations from local protocols, national guidelines and research about number of visits, screening for gestational diabetes (GDM), syphilis, hepatitis C (HCV), and HIV, and advice on smoking cessation. SETTING: Australian public hospitals with more than 200 births/year, some smaller hospitals in each State and Territory, and all Divisions of General Practice were contacted in 1999 and 2000. We reviewed 107 protocols, which included 80% of those requested from hospitals and 92% of those requested from Divisions. MAIN OUTCOME MEASURES: Frequency and consistency of recommendations. RESULTS: Recommendations about syphilis testing were notable in demonstrating consistency between local protocols, national policies and research evidence. Most protocols recommended screening for GDM, despite lack of good evidence of its effectiveness in improving outcomes. Specific approaches to screening for GDM varied widely. Coverage and specific recommendations about testing for HIV and HCV were also highly variable. Smoking-cessation information and advice was rarely included, despite good evidence of the effectiveness of interventions in improving outcomes. No national policies about the number of routine visits and smoking cessation could be identified. There were inconsistent national policies for both HIV and GDM screening. CONCLUSIONS: Antenatal care recommended in protocols used in Australia varies, and is not always consistent with national policies or research evidence. Producing and disseminating systematic reviews of research evidence and national guidelines might reduce this variability and improve the quality of Australian antenatal care.