Evaluation Studies on Tobacco Smoking Health Promotion Programs for the Indigenous Australian Population

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Literature Review:
Evaluation Studies on Tobacco Smoking Health Promotion Programs for the Indigenous Australian Population

Tobacco smoking is one of the main causes of major diseases in Australia and is still the largest single preventable cause of death (AIHW, 2008). Smoking counts for 15,500 deaths annually and higher mortality and morbidity are found among Indigenous populations (AIHW, 2008). In Australia, the smoking prevalence is higher among the Aboriginal People and Torres Strait Islanders. Approximately 34.1% of Indigenous Australians are smoking, compared to only 19% in the general populations (ABS, 2006). The high smoking prevalence is highly correlated with the premature deaths and morbidity among Indigenous people, which mainly caused by cardiovascular disease, respiratory disease and other diseases related to tobacco use, resulting in 18 years of life expectancy gap between Indigenous people and the general populations (AIHW, 2008).

Australia is one of the most successful countries in implementing smoking cessation programs, but unfortunately Indigenous population’s smoking rates remain high (AIHW, 2008). This disparity between the Indigenous and Australian general population is highly correlated with the differences in health determinants (Lindorff, 2002), such as the lower socioeconomic status and cultural differences. Therefore, in order to address smoking problems in this particular community, there is a need to also address these determinants, such as culturally-appropriate approaches and economically feasible smoking cessation programs.

The current smoking cessation programs are well documented and evaluated for the Australian general populations, but unfortunately not for Indigenous people. There have been few discussions regarding which smoking interventions are effective for Indigenous population (Boffa et al. 2009) and about the potential of existing programs for this particular population. This review analyzes several evaluation studies on smoking cessation programs and their limitations. In the conclusion, this paper gives several recommendations on how to improve the evaluations and suggestions on programs that have potential benefit if applied in the Indigenous populations.

Health Promotion Interventions
This review analyzes the evaluations of two types of smoking cessation programs; quit smoking programs in individual or group basis, and health promotion program which uses social marketing approach such as quit smoking advertisements which cover larger communities.

Quit smoking programs
There are strong evidences supporting the use of pharmacotherapy and counseling in helping smokers to quit their smoking behavior (Raw et al. 1999; Ivers, 2004). In Aboriginal population, there have been numerous projects in smoking cessation, but there are only limited evaluation studies on current programs. The following review discussed two evaluation studies on smoking cessation programs with several differences and findings.

There are a number of studies evaluating smoking cessation programs which use the combination of counseling and nicotine replacement therapy (Ivers et al. 2003; Mark et al. 2004). The evaluation study by Mark et al (2004) took place in an Aboriginal community in New South Wales, using qualitative and quantitative methods to assess the smoking cessation program with three months follow up. The program used the combination between support groups and nicotine replacement therapy (NRT). In this evaluation study, selected participants were assessed using pre and post-course surveys with a three months follow up. In the end of the program, only 6.1% of the participants remain tobacco-free. When asked the reason or difficulties in quitting smoking, respondents complained the side effects of NRT, including skin irritation, nightmares and tiredness. There was also no supportive environments which keep the smokers motivated to quit smoking, for example their...
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