Stressful life events, resources, and access: key considerations in quitting smoking at an Aboriginal Medical Service

Abstract

Objective: Aboriginal and Torres Strait Islander people experience adverse health outcomes and have high rates of smoking and related illnesses. This brief report describes stress as a barrier to quitting smoking derived from reflections within an Aboriginal Medical Service and makes recommendations for intervention development. Methods: A high‐intensity smoking cessation program was conducted within a suburban Aboriginal Medical Service in Western Sydney, Australia, over a 10‐month period. The intervention included weekly cessation counselling sessions and dispensation of free nicotine replacement therapy (NRT). Results: During the observation period, 32 clients made quit attempts. To date, three clients (9%) have quit smoking. Chronic and intercurrent life stressors were noted to be the main barriers to smoking cessation described by participants. Conclusions: Achieving smoking cessation among Indigenous people is made significantly more complex because of multiple life stressors experienced. Implications: Future interventions targeting Indigenous Australians should take greater account of stressful life events and their impact on quitting smoking.

The quality of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review

“…• SEWB (nine studies) 19,20,[25][26][27][28][29][30][31][32][33][34] • Alcohol misuse (five studies) 21,22,[35][36][37][38] • Smoking cessation (four studies) 23,24,[39][40][41] • Dual diagnosis -SEWB and drug or alcohol misuse (three studies) 17,18,42,43 • Depression 44,45 , depression or anxiety 46 , or a mental health worker program (four studies). 15,16 Nineteen studies were conducted in AMSs , six of which used mixed methods [17][18][19][20]30,31,37 and one of which was a quasiexperimental design.…”

“…21,22,27,28,33,36,45 One case study was included. 40 Participatory action research principles were used in combination with yarning techniques 41 , a social-ecological perspective 23,24 or as part of a mixed- Research teams: including primary health care staff, community members and researchers located outside the community methods study. 19,20 Two-way learning approaches were described by three studies.…”

“…In 12 studies, the risk of bias was judged to be high 19,20,27,28,30,[33][34][35]37,46 or unclear 21,22,36,40,45 , four were at moderate risk of bias 19,20,25,26,41,42,44 and five were at a low risk of bias. 23,24,29,31,39,43 AIMhi 1 was assessed using the qualitative 19 and randomised controlled trial 20 risk-of-bias tools, because these methods were reported separately.…”

“…25,26 We were unable to identify primary outcomes in eight studies. These included a case study 40 ; AIMhi 2 30 ; the AIMhi Priority Driven Research Partnership 32 ; a study to develop and assess a psychological assessment tool 44 ; and projects focused on depression 46 , a case management model 38 and capacity development relating to dual diagnosis. 17,18 The primary outcome was somewhat met in one study, where a workplace policy was developed as planned, but acceptability testing was pending.…”

“…27,28,33,34 Study initiation process Seven studies appeared to be initiated by researchers external to the primary health care service 23,24,27,28,[33][34][35][36][37] , seven arose from research partnerships 15,16,19,20,[30][31][32]38,46 and three appeared to be jointly initiated. 25,26,40,42 A community also invited a researcher from outside the community to evaluate a SEWB service. 29 It was unclear how the remaining seven studies were initiated.…”