Smoking and quitting characteristics of Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study

Abstract

Objective: To describe smoking characteristics, quitting behaviour and other factors associated with longest quit attempt and the use of nicotine replacement therapy (NRT) and stop-smoking medication (SSM) in a population of Indigenous Australian women of reproductive age.Design, setting and participants: A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16-49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. Main outcome measures:Quitting experience: attempt to cut down, time since last quit attempt, longest period without smoking, attempt to cut down during last quit attempt, any use of NRT and/or SSM.Results: Most of the 428 participating women (302 [70.6%]) reported using an Aboriginal health service. Younger women (16-20-year-olds) smoked fewer cigarettes daily (24/42 [57.1%], 0-5 cigarettes per day), waited longer to smoke after waking (20/42 [47.6%], > 60 minutes after waking), and were categorised as low smoking dependency compared with those aged 35 years and over. One-third of women (153 [35.7%]) had ever used NRT and/or SSM. A greater proportion of older women (35-49-year-olds) had sustained a quit attempt for years (62/149 [45.6%]) and reported trying NRT and/or SSM (78/149 [52.4%]) than women in younger age groups. Quitting suddenly rather than gradually was significantly associated with sustained abstinence (prevalence ratio, 1.27 [95% CI, 1.10-1.48]). Among women who had never used NRT or SSM, most (219/275 [79.6%]) reported reasons for this in the category of attitudes and beliefs. NRT and SSM use was also more likely among women who were confident talking to their doctor about quitting (odds ratio, 2.50 [95% CI, 1.23-5.10]) and those who received most of their information from a health professional (odds ratio, 1.71 [95% CI, 1.11-2.63]). Conclusion:Aboriginal and Torres Strait Islander women want to quit smoking and are making attempts to quit. Quitting suddenly, rather than reducing cigarette consumption, is associated with increased sustained abstinence. Health providers can enable access and uptake of NRT and/or SSM and should recognise that NRT and/ or SSM use may change over time. Consistent messaging, frequent offers of smoking cessation support, and access to a range of smoking cessation supports should be provided to Aboriginal and Torres Strait Islander women to enable them to be smoke-free.The known: National priorities to reduce smoking rates during pregnancy among Aboriginal and Torres Strait Islander women are in place, but little published evidence exists to inform strategies to address these priorities.The new: Aboriginal and Torres Strait Islander women are making quit attempts and 36% have used nicotine replacement therapy and/or stop-smoking medications. Age, measures of nicotine dependence and remoteness are not associated with sustained quitting. Quitting suddenly, rather than reducing cigarette consumption, is associated with sustained abstinence.The implications: Health providers should suppo...

Smoking cessation support strategies for Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study

“…The sample demographics are detailed elsewhere in this supplement. 13 A total of 428 Aboriginal and Torres Strait Islander women with a mean age of 30.5 years completed the survey and were included in the analyses. Half resided in urban areas (49.5%).…”

“…The survey details and sampling frame are reported elsewhere in this supplement. 13 Participants' ages were categorised as 16-20 years, 21-34 years, or 35-49 years; remoteness as urban, or regional or remote; and education as completing up to year 11, completing year 12 or current student (TAFE or university) or apprentice, or having completed a degree or trade certificate. Participants were categorised as using an AHS or not; by smoking status (current smoker or ex-smoker [any intensity]); and by smoking intensity (0-5 in cigarettes per day [CPD], 6-10 CPD, or ≥ 11 CPD).…”

Miilwarranha (opening): introducing the Which Way? study

“…Evidence included in this MJA supplement aims to privilege Aboriginal and Torres Strait Islander women in the development of Indigenous-led evidence on smoking cessation care. 7,8 Most health care providers have and will continue to encounter Aboriginal and Torres Strait Islander peoples in their daily practice. As such, identifying respectful and effective strategies that resonate with Aboriginal and Torres Strait Islander peoples to quit tobacco use, particularly during pregnancy, through health care systems are required.…”

“…Given the lack of Indigenous-specific evidence and the substantial room for improvement in health outcomes, the Which Way? study, reported in this supplement of the MJA, 7,8 aims to address an urgent need to better understand smoking, for and by Aboriginal and Torres Strait Islander women, using community-led research questions informed through an Indigenous lens. 23 In the words of Linda Tuhiwai Smith:…”

Ngaaminya (find, be able to see): summary of key findings from the Which Way? project

“…The cross‐sectional results from the Which Way? project are outlined in this supplement 1,2 and summarised in the Box. This project has provided the first Indigenous‐led primary evidence on smoking and cessation behaviour of Aboriginal and Torres Strait Islander women of reproductive age.…”