Developing and implementing a state-wide Aboriginal health promotion program: the process and factors influencing successful delivery.

ISSUE ADDRESSED: The prevalence of smoking among the adult Aboriginal population is almost double that of the non-Aboriginal population. Research shows smoking cessation brief interventions have a positive impact on quit attempts. However, examples of statewide, Aboriginal-led initiatives that ensure health service delivery of brief intervention to all Aboriginal clients are limited. METHODS: Guidance from an Aboriginal chief investigator and key health stakeholders supported the development of the NSW SmokeCheck Program. One component of the program was the establishment of a state-wide network of Aboriginal Health Workers (AHWs) and other health professional participants. Another was a culturally specific training program to strengthen the knowledge, skills, and confidence of participants to provide an evidence-based brief smoking-cessation intervention to Aboriginal clients. The brief intervention was based on the transtheoretical model of behaviour change, adapted for use in Aboriginal communities. RESULTS: SmokeCheck training reached 35.5% of the total NSW AHW workforce over a 15-month period. More than 90% of participants surveyed indicated satisfaction with the curriculum content, workshop structure and training delivery, agreeing that they found it relevant, easy to understand and applicable to practice. CONCLUSIONS: An evidence-based approach to designing and delivering an Aboriginal-specific health promotion intervention appears to have facilitated the development of a state-wide network of Aboriginal and non-Aboriginal health professionals and strengthened their capacity to deliver a brief smoking cessation intervention with Aboriginal clients.

Maternal smoking during pregnancy among Aboriginal women in New South Wales is linked to social gradient.

OBJECTIVE: Social gradients in Aboriginal health are seldom explored. This study describes social gradients and trends in smoking during pregnancy among Aboriginal mothers in NSW. METHODS: This was a secondary analysis of the NSW Midwives Data Collection (MDC) 1994-2007, covering all births in NSW. Analyses examined associations between socio-demographic characteristics and smoking during pregnancy. RESULTS: Data from 1,214,206 pregnant women showed that 17.4% smoked during pregnancy. The rate of smoking during pregnancy among all NSW women declined from 22.3% in 1994 to 12.8% in 2007; the rate among Aboriginal women remained high, declining from 61.4% in 1994 to 50.2% in 2007. Smoking was substantially higher among Aboriginal mothers compared to non-Aboriginal mothers. Socio-economic analyses showed that the smoking rate among low SES Aboriginal mothers was approximately two and a half times that of high SES Aboriginal women, a similar gradient to non-Aboriginal women. CONCLUSIONS: Indicators of socio-economic position are a consistent, independent correlate of smoking during pregnancy for Aboriginal and non-Aboriginal women. IMPLICATIONS: There is a need for a social inequalities approach to smoking during pregnancy, specifically targeting more disadvantaged Aboriginal mothers and all teenage mothers for smoking prevention. Strategies to access more disadvantaged mothers should not be missed through broadly focused Aboriginal tobacco control strategies.

Evaluating NSW SmokeCheck: a culturally specific smoking cessation training program for health professionals working in Aboriginal health.

ISSUE ADDRESSED: This paper reports on the evaluation of a culturally specific smoking cessation training program (SmokeCheck) for health professionals working in Aboriginal health in NSW. Training aimed to increase professionals' knowledge, skills and confidence to offer an evidence-based quit smoking brief intervention to Aboriginal clients. METHODS: Using a quasi-experimental pre-post with 165 matched intervention participants, surveys were completed immediately before (baseline) and 6-months post training. The control group were on a waiting list for 6 months before receiving the intervention, and completed surveys at baseline, immediately before training and 3-6 months following training. Surveys assessed knowledge, skills and confidence to deliver the intervention, availability of resources, and smoke-free status of homes. RESULTS: Post training, a higher proportion of intervention group participants were more confident talking about health effects (22%, p=0.001), offering quit advice (27%, p=0.001), assessing readiness to quit (31%, p=0.001) and initiating a conversation about smoking (24%, p=0.001). After training, more participants reported providing advice about NRT (15%, p=0.001), ETS (12%, p=0.006), and reducing tobacco use (10%, p=0.034), but no changes were reported in smoking or intention to quit. Conversely, the control group showed no significant changes. CONCLUSIONS: SmokeCheck training strengthened participants' knowledge, skills and confidence to deliver a smoking cessation intervention to Aboriginal clients.'