RESUMO
ISSUE ADDRESSED: High smoking rates among the disadvantaged lead to inequalities in health, quality-of-life and financial well-being. Non-government social and community service organisations (SCSO) are a promising setting for tobacco control interventions targeting disadvantaged smokers. METHODS: Financial grants were provided to twenty SCSO in New South Wales to support multi-level changes in service culture, smoking related policies and cessation support between 2007 and 2009. Evaluation was conducted using a mixed-methods approach that included key informant interviews, document analysis and staff survey data. RESULTS: SCSO working with disadvantaged clients can feasibly implement tobacco control activities, including smoking-related policy changes and cessation support. Tobacco control activities were generally acceptable to staff and clients, and staff pessimism regarding their clients' ability to quit reduced, as did the acceptability of staff smoking with their clients. Improvements in levels of organisational support for cessation training and resources, smoking policies and provision of free nicotine replacement therapy (NRT) were reported. Within mental health SCSO there was a positive response from staff to cessation support, financial benefits of quitting and the role of NRT. CONCLUSIONS: The evaluation pointed to the acceptability and feasibility of engaging disadvantaged smokers by SCSO, and that tobacco policy and attitude changes can be achieved by small investments, such as grant programs.
Assuntos
Promoção da Saúde/organização & administração , Áreas de Pobreza , Prevenção do Hábito de Fumar , Apoio Social , Seguridade Social , Adulto , Austrália , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Fumar/etnologia , Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar , Poluição por Fumaça de Tabaco/legislação & jurisprudênciaRESUMO
BACKGROUND: Smoking rates remain unacceptably high among individuals who are socially disadvantaged. Social and community service organisations (SCSO) are increasingly interested in providing smoking cessation support to clients, however little is known about the best way to assist disadvantaged smokers to quit in this setting. This study aimed to explore barriers and facilitators to quitting within the conceptual framework of the PRECEDE model to identify possible interventions appropriate to the social and community service setting. METHODS: Semi-structured focus groups were conducted with clients attending five community welfare organisations located in New South Wales, Australia. Thirty-two clients participated in six focus groups. A discussion guide was used to explore the barriers and facilitators to smoking and smoking cessation including: current smoking behaviour, motivation to quit, past quit attempts, barriers to quitting and preferences for cessation support. Focus groups were audio-taped, transcribed and analysed using thematic analysis techniques. RESULTS: Participants were current smokers and most expressed a desire to quit. Factors predisposing continued smoking included perceived benefits of smoking for stress relief, doubting of ability to quit, fear of gaining weight, and poor knowledge and scepticism about available quit support. The high cost of nicotine replacement therapy was a barrier to its use. Continual exposure to smoking in personal relationships and in the community reinforced smoking. Participants expressed a strong preference for personalised quit support. CONCLUSIONS: Disadvantaged smokers in Australia express a desire to quit smoking, but find quitting difficult for a number of reasons. SCSOs may have a role in providing information about the availability of quit support, engaging disadvantaged smokers with available quit support, and providing personalised, ongoing support.
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Atitude Frente a Saúde , Redes Comunitárias , Promoção da Saúde/organização & administração , Pobreza , Desenvolvimento de Programas/métodos , Abandono do Hábito de Fumar , Feminino , Grupos Focais , Humanos , Masculino , New South Wales/epidemiologia , Fumar/epidemiologiaRESUMO
Reaching disadvantaged groups for smoking cessation represents a significant challenge. Not-for-profit community service organizations (CSOs) represent a promising setting for the delivery of quit smoking support to disadvantaged smokers. However, their potential has not yet been explored. This qualitative study examined the acceptability of community service-delivered smoking cessation care. In-depth interviews and focus groups were conducted with 8 managers, 35 staff and 32 clients of CSOs between December 2008 and March 2009 in New South Wales, Australia. Discussions were audiotaped, transcribed and analysed using thematic analysis techniques. Quantitative surveys were also conducted to explore preferences for cessation support. Results showed that the acceptability of providing and receiving cessation support in the community service setting was high. Staff perceived the provision of quit support to be compatible with their role but reported barriers to providing care including competing priorities, insufficient resources and inadequate staff training. Brief intervention approaches were preferred by managers and staff, while financial incentives and access to free or subsidized nicotine replacement therapy (NRT) were desired by clients. The community service setting represents a promising access point for engaging disadvantaged smokers for cessation and further research exploring the effectiveness of support delivered in this setting is clearly warranted.
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Abandono do Hábito de Fumar/métodos , Apoio Social , Seguridade Social , Populações Vulneráveis , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , New South Wales , Organizações sem Fins LucrativosRESUMO
ISSUE ADDRESSED: smoking rates among very disadvantaged populations groups are much higher than for the general Australian population. Smoking makes a significant contribution to the reduced health and material well-being experienced by these groups. Community service organisations have been suggested as a promising setting to provide smoking cessation support for disadvantaged people, but few initiatives have explored the feasibility of this strategy. METHODS: the project involved work with five non-government community service organisations as demonstration sites for the integration of smoking care. Sites were offered staff training, smoking-care resources and policy support to address tobacco in the service environment and in their work with clients. Pre-and post-training surveys were undertaken with training participants and a follow-up survey was conducted after three months. Survey questions assessed staff members' confidence, knowledge and skills to address smoking, as well as changes in staff practice. RESULTS: the response rate for the surveys before and after the training sessions was almost 100%, with 63 of the 64 participants providing post-training surveys. The response rate of the three-month follow-up survey was approximately 50% with 34 respondents. Findings indicate that staff did develop confidence, skills and knowledge to address tobacco issues. Some organisations made changes to policy, such as introducing designated smoking areas and providing financial support for clients and staff to quit smoking. Practice change was evident among some staff, particularly in addressing smoking as part of routine case management and use of the 5A's brief intervention framework. CONCLUSIONS: the project findings lend support to the view that community service organisations could play a role in providing smoking care to disadvantaged people.
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Promoção da Saúde/organização & administração , Abandono do Hábito de Fumar/métodos , Seguridade Social , Adolescente , Adulto , Austrália , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Masculino , Fatores SocioeconômicosRESUMO
Fluridone is widely used as a herbicide for controlling invasive aquatic plants such as hydrilla in surface water bodies. When applied on surface waters fluridone can attach to bed sediment, requiring rigorous extraction methods prior to analysis. Currently, very limited information exists in terms of fluridone residue detection in delta sediment. In this study, we researched fluridone detection in both water and sediment. To extract fluridone from sediment, here we have tested two extraction methods: (1) a rotavapor method (RM); and (2) a quick, easy, cheap, effective, rugged and safe (QuEChERS) method (QM). The extraction results of RM were compared with those of QM. To quantify fluridone concentrations in extracts, a high-performance liquid chromatography (HPLC)-UV detector was used. HPLC separation was achieved using an Allure C18 5 µm 150 × 4.6 mm column with a mobile phase composed of acetonitrile and water (60:40, v/v). The UV detector was operated at 237 nm. The method was tested and validated using a series of water and sediment samples taken from Sacramento-San Joaquin Delta in California. The average recovery of fluridone was 73% and 78% using RM and QM respectively. The proposed method can be used for testing fluridone in water and sediment samples.
RESUMO
ISSUE: While population wide smoking rates are falling steadily the rates remain high among the disadvantaged. The future we face is one where the differentials in smoking rates will continue to widen and will flow through to increased health inequalities. APPROACH: How best to reduce smoking rates among the disadvantaged? Alongside existing population level initiatives and social policy initiatives is an urgent need for a targeted, comprehensive approach that acknowledges the serious impact of smoking on the disadvantaged. In 2006 Cancer Council NSW embarked on a statewide, multi-component Tackling Tobacco Program to encourage and support non-government social and community services to address smoking among their clients. KEY FINDINGS: Tackling Tobacco Program results have shown that the 1600 staff from 400 organisations trained to provide smoking care can attain the knowledge and confidence to address tobacco and that clients are very receptive to receiving quit support from them. Improvements in quality of life for clients who do quit have been encouraging and the Tackling Tobacco Program has challenged assumptions and attitudes that disadvantaged people are uninterested and unable to quit. IMPLICATIONS: Alongside population and social policy approaches must be a serious investment in tackling smoking among the disadvantaged. CONCLUSIONS: Tackling Tobacco Program is an innovative example of how to engage disadvantaged smokers, de-normalise smoking and encourage and support quitting using familiar settings. Engaging Australia's large network of social and community services as allies in this work should be vigorously pursued.
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Disparidades nos Níveis de Saúde , Política Pública , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Austrália/epidemiologia , Serviços de Saúde Comunitária/organização & administração , Humanos , New South Wales/epidemiologia , Formulação de Políticas , Desenvolvimento de Programas , Qualidade de Vida , Fumar/epidemiologia , Fatores SocioeconômicosRESUMO
INTRODUCTION AND AIMS: Novel ways of accessing and engaging smokers who are socially and economically disadvantaged may help reduce socioeconomic disparities in smoking rates. This study assessed the feasibility and acceptability of integrating smoking cessation support into usual care at a social and community service organisation (SCSO). DESIGN AND METHODS: One SCSO providing a Personal Helpers and Mentors program participated. Support workers were provided with training in 5A's, brief motivational interviewing and use of nicotine replacement therapy, and then recruited clients into a 6 month smoking program. Acceptability and feasibility was assessed prior to receiving training and at 3 and 6 month follow up for support workers, and at enrolment into the program and at 4 and 6 month follow up for clients. RESULTS: Six support workers (67%) and 20 of their clients (65%) took part. Overall acceptability of the program was high, particularly among clients. The amount of time spent talking about smoking increased from 3.8 min per visit at baseline to 15.5 min at 6 month follow up. There was a significant reduction in the number of cigarettes smoked from 20.5 cigarettes per day at baseline to 15 cigarettes per day at 6 month follow up (P = 0.04). DISCUSSION AND CONCLUSIONS: SCSOs are both interested in and capable of providing smoking care and the majority of clients found the smoking cessation intervention acceptable and helpful. Given the demonstrated acceptability and feasibility of this approach, further research to determine the effectiveness of this approach is warranted.
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Serviços de Saúde Comunitária/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Adulto , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenvolvimento de Programas , Fumar/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo , Dispositivos para o Abandono do Uso de TabacoRESUMO
INTRODUCTION AND AIMS: New strategies are required to reach subpopulations with high smoking rates. This study reports on an evaluation of the Smoking Care intervention-a 2-year organisational capacity building strategy--for social and community service organisations (SCSOs) to provide smoking care to clients. DESIGN AND METHODS: The Smoking Care intervention consisted of: awareness raising seminars (half-day); smoking cessation training (1 day) and; nicotine replacement therapy grants (3 months). Baseline and 3-month follow-up data were collected within participating SCSOs and the primary outcomes measured were: changes in staff attitudes, confidence and practice of smoking cessation care. Changes in client self-reported smoking behaviours, quit attempts and interest in quitting were also measured. RESULTS: Of 600 staff who attended training, 306 (51%) returned pre- and post-intervention surveys. At 3-month follow-up staff reported statistically significant increases in positive attitudes to providing smoking cessation care, increased confidence in providing such care and increases in cessation practice. Of 400 client surveys distributed, 367 (92%) were returned at pre-intervention and 255 (64%) at post-intervention. Fewer clients reported daily smoking at post-intervention, while use of nicotine replacement therapy and group counselling increased significantly. Client interest in quitting and receiving quit support from case workers was high at both pre- and post-intervention. DISCUSSION AND CONCLUSIONS: The intervention had an impact on SCSO staff attitudes, confidence and provision of smoking care. Results show clients were receptive to this support. More rigorous testing of similar interventions in SCSOs is warranted.