"It's changed my life. I'm not smoking anymore. I don't want to smoke anymore": exploring the acceptability of mailout smoking cessation support for and by Aboriginal and Torres Strait Islander people.

INTRODUCTION: Aboriginal and Torres Strait Islander people want to quit smoking. There is global evidence of combination Nicotine Replacement Therapy (c-NRT) alongside behavioural support as best practice approach to smoking cessation care. However, there is limited adherence and acceptability research regarding NRT and behavioural supports for Aboriginal and Torres Strait Islander people. Similarly, there is limited research on what is considered culturally appropriate and safe support for Aboriginal and Torres Strait Islander people to quit smoking. METHODS: This Aboriginal-led qualitative study explored the acceptability of the Koori Quit Pack. Aboriginal and Torres Strait Islander participants shared experiences of quitting with the mailout c-NRT program and behavioural cessation support through Yarning. Reflexive thematic analysis was used to develop themes. RESULTS: Aboriginal and Torres Strait Islander people are motivated to quit smoking and have accessed cessation supports from health professionals. However, the support(s) received are not always appropriate or culturally safe. The Koori Quit Pack was deemed acceptable and useful for smoking cessation. Having access to smoking cessation care and knowledge of c-NRT helped people quit smoking, and support others to quit too. CONCLUSION: A combination of NRT products alongside culturally responsive behavioural support(s), delivered through a mailout package was a beneficial strategy to help Aboriginal and Torres Strait Islander people quit smoking. National implementation of such a package could assist to accelerate reductions in tobacco use, helping meet national smoking reduction targets and improve health outcomes. IMPLICATIONS: Cessation supports offered to Aboriginal and Torres Strait Islander people are not always culturally-safe or effectively delivered. The Koori Quit Pack provided Aboriginal and Torres Strait Islander people with culturally-safe smoking cessation support delivered for and by Aboriginal and Torres Strait Islander people, demonstrating mailout smoking cessation supports as acceptable and highly valued. Mailout support eliminates accessibility barriers to cessation care while providing tools and knowledge to quit can lead to smoke-free behaviours among individuals and communities. Country-wide availability of this program can accelerate reductions in tobacco use, helping meet national targets and improve health outcomes consistent with the National Tobacco Strategy and the WHO Framework Convention on Tobacco Control.

SISTAQUIT: training health care providers to help pregnant Aboriginal and Torres Strait Islander women quit smoking. A cluster randomised controlled trial.

BACKGROUND: About 44% of Indigenous Australian women smoke during pregnancy, compared with 12% of pregnant non-Indigenous women. Health care providers can assist smoking cessation, but they are not typically trained in culturally appropriate methods. OBJECTIVES: To determine whether a health care worker training intervention increases smoking cessation rates among Indigenous pregnant smokers compared with usual care. METHODS AND ANALYSIS: Supporting Indigenous Smokers to Assist Quitting (SISTAQUIT) study is a multicentre, hybrid type 1, pragmatic, cluster randomised controlled trial that compares the effects of an intervention for improving smoking cessation by pregnant Indigenous women (16 years or older, 32 weeks' gestation or less) with usual care. Twenty-one health services caring for Indigenous people in five Australian jurisdictions were randomised to the intervention (ten sites) or control groups (eleven sites). Health care providers at intervention sites received smoking cessation care training based on the ABCD (ask/assess; brief advice; cessation; discuss psychosocial context) approach to smoking cessation for Indigenous women, an educational resource package, free oral nicotine replacement therapy for participating women, implementation support, and trial implementation training. Health care providers in control group services provided usual care. PRIMARY OUTCOME: abstinence from smoking (self-reported abstinence via survey, validated by carbon monoxide breath testing when possible) four weeks after enrolment in the study. SECONDARY OUTCOMES: health service process evaluations; knowledge, attitudes, and practices of health care providers; and longer term abstinence, perinatal outcomes, and respiratory outcomes for babies (to six months). Ethics approval: The human research ethics committees of the University of Newcastle (H-2015-0438) and the Aboriginal Health and Medical Research Council of NSW (1140/15) provided the primary ethics approval. Dissemination of results: Findings will be disseminated in peer-reviewed publications, at local and overseas conferences, and via public and social media, and to participating health services in art-based formats and reports. Policy briefs will be communicated to relevant government organisations. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, ACTRN12618000972224 (prospective).

Perspectives about smoking cessation during pregnancy and beyond of Aboriginal women in Australia: A qualitative analysis using the COM-B model.

OBJECTIVE: Aboriginal and Torres Strait Islander women (hereafter Aboriginal) and their babies experience poor health outcomes for which smoking is a major risk factor. This paper explores Aboriginal women's perspectives on and experiences of smoking cessation, within and outside pregnancy, and their use of smoking cessation services using the COM-B (Capability, Opportunity, Motivation as determinants of Behaviour) model to understand Aboriginal women's capabilities, opportunities, and motivation for smoking cessation. METHODS: Data came from 11 focus groups conducted in regional New South Wales, Australia, with 80 women aged between 16 and 68 years. Thematic analysis was performed following the COM-B model. RESULTS: Seven themes related to capability, opportunity, motivation, and smoking cessation behaviors were identified. The themes highlighted that agency, knowledge, and self-efficacy (as capability), a supportive social environment, and access to culturally appropriate services and resources (as opportunities), together with automatic and reflective motivations for quitting, may enable short- or long-term smoking cessation. CONCLUSION: Smoking cessation interventions may be more effective if the dynamics of the COM-B factors are considered. Policy and practice changes for further enhancing regional Aboriginal women's psychological capability and supportive social environments, and making smoking cessation services culturally appropriate are warranted.