Smoking Cessation in Indigenous Populations of Australia, New Zealand, Canada, and the United States: Elements of Effective Interventions

Abstract

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990–2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.

Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis

“…Little is yet known about the natural history of quitting for an Indigenous smoker. In the interim, steps need to be taken to ensure that Indigenous populations are not disadvantaged by inequities in access to media broadcasting,64 IT technology65 and effective treatments, should they wish or need to use them 66…”

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

“…Limited but available evidence does show smoking cessation interventions specifically targeted at Indigenous populations can result in smoking abstinence.Carson 2015 [36](Unclear)High‘Culturally tailored interventions for smoking cessation in indigenous populations: A Cochrane systematic review and meta-analysis’AllAny (focus on cultural tailoring)9Randomised or non-randomised controlled trials [9]Mainly pooled effect estimates from meta-analysisSmoking cessation: Non-sig effect (risk ratio1.43 (95% CI 0.96 to 2.14); p  = 0.08, 7 studies).Some evidence supports using culturally tailored smoking cessation interventions for Indigenous populations. Most effective interventions were multifaceted cognitive and behavioural, mixing several initiatives simultaneously with health professional participationDiGiacomo 2011 [22](1990-2010)Moderate‘Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: elements of effective interventions’AllSmoking cessation9Randomised controlled trials and cluster RCT’s [1]Non-randomised [8]Mainly qualitative and descriptive statementsQuit rates: Higher quit rates reported for bupropion vs. placebo.Prevalence reduction: Mixed results from 5 studies.Cultural considerations: Describes cultural tailoring and levels of community engagement.Workforce/organisation: Describes Indigenous workforce involvement, organisational support, and financial/transport assistance for clients.Self-determination/flexibility: Describes programme flexibility and availability.Partnerships and engagement: Discusses strategies to promote engagement and principles for establishing partnerships.Few identified interventions tailored for Indigenous populations. Successful interventions featured integrated, flexible, community-based approaches that addressed known barriers/facilitators to quit smoking.CADTH 2013 [38](Jan 1 2003 to Jun 26 2013)Moderate‘Indigenous Knowledge for Smoking Cessation: Benefits and EffectivenessAllIndigenous knowledge for smoking cessation1Systematic review [1]Mainly qualitative statementsNo studies found in systematic review.No evidence regarding Indigenous knowledge for smoking cessation was identified.Gould 2013a [25](Up to Oct 2011)LowShould anti-tobacco media messages be culturally targeted for Indigenous populations?…”

Tobacco Cessation Interventions for Underserved Women

“…Together, these studies suggest that integrating social support in tobacco dependence treatment might be particularly beneficial for diverse subgroups of women. However, a recent review also notes the dearth of research into smoking cessation programs that include social support for Aboriginal communities (DiGiacomo et al, 2011).…”