NACCHO smoke free news: Aboriginal smoking program cuts risk widening the gap



Tobacco use is the leading cause of preventable disease and early death among Indigenous Australians, with smoking responsible for about one in every five deaths.


Among Indigenous Australians, tobacco use contributes to 80% of all lung cancer deaths, 37% of heart disease, 9% of all strokes and 5% of low birth-weight babies. And in central Australia, rates of pneumonia among children are reported to be the highest in the world, reaching 78.4 cases per 1,000 children every year.

Although we are seeing reductions in smoking rates across Australia, 42% of Aboriginal and Torres Strait Islander (TSI) people are daily smokers, compared to 16% in the non-Indigenous population. In some remote communities this estimate is as high as 83%.

Smoking is also higher among vulnerable groups: up to two-thirds of Indigenous women continue to smoke during pregnancy, and around 39% of young people aged 15 to 24 years are smoking daily.

You’d think governments would be redoubling their efforts to address the problem. Not so. In fact, the Australian government has recently announced funding cuts of A$130 million over five years to the Tackling Indigenous Smoking program, which amounts to more than one-third of the program’s annual funding.

Tackling Indigenous Smoking funds teams of six health workers to run tailored anti-smoking programs. Each is designed with input and involvement from each community and employ local quit-smoking role models who help other smokers quit by offering advice and support.

Benefits of quitting

We know that quitting smoking reduces the risks of heart disease, lung cancer and other smoking-related issues.

But there are also significant benefits for the health-care system and Australian longer-term budget’s. A recent South Australian study led by Professor Brian Smith, for instance, helped smokers to quit while in hospital and found a direct saving to the hospital budget of A$6,646 per successful quitter within just 12 months.

Another study estimated that the economic impact from just an 8% reduction in the prevalence of tobacco smoking in Australia would result in 158,000 fewer incident cases of disease, 5000 fewer deaths, 2.2 million fewer lost working days and 3000 fewer early retirements. Overall, an 8% reduction in smoking would reduce health sector costs by AU$491 million.

Assessing and funding what works

One of the complicating factors is that the success of Indigenous anti-smoking programs has been patchy. A review I recently published in the Cochrane Collaboration found significant shortcomings for Indigenous quit smoking and youth tobacco prevention programs.

Only one quit smoking study, which was performed in the Northern Territory by Dr Rowena Ivers, met the quality criteria. Dr Ivers’ study found that free nicotine patches might benefit a small number of Indigenous smokers. But none of the study participants completed the full course of nicotine patches and only seven people from the original total of 111 reported that they had quit smoking at six months.

This study suggests programs using nicotine patches can help Indigenous smokers to quit. But much more evidence is needed to determine what options really are the most effective.

Likewise, another review of tobacco prevention programs among young people found potentially harmful results, with one of the three identified studies showing lower smoking rates in the control population. This means that children who received the tailored tobacco prevention program did worse than the youth in the control group who received nothing at all.

It is important to continue evaluating Tackling Indigenous Smoking programs so we know whether or not they work and can direct funding to programs that make a difference. So it’s concerning that part of the funding that is being cut from the budget relates to reviewing these programs.

A long way to go

Five years into the Tackling Indigenous Smoking project, the government has invested a substantial amount of time and money into developing these culturally-tailored programs. Preliminary data released by the government in April found a 3.6% fall in Indigenous daily smoking rates between 2008 and 2013 and a reduction in smoking during pregnancy of 3%.

But cutting resources will make it impossible to meet the program’s ambitious goal of halving Indigenous smoking rates by 2018.

There is still a long way to go. Research shows many health-care workers and some doctors who treat smokers do not believe they have the skills or ability to offer effective preventive health advice. Worryingly, they also admit to the attitude of “even if I did, it’s not going to work, so why bother”.

This response tells us that much more work and subsequently funding is needed to really address the health gaps that remain between Indigenous and non-Indigenous Australians. Tobacco use will remain a problem within our society for as long as we continue to allow it to be one.

NACCHO Aboriginal health :Cats give healthy living message a kick forward


Travis Varcoe chats with Warrnambool’s Fiona Clarke at the Gunditjmara co-operative’s health Centre yesterday.

EATING healthy can become an empty message — unless you’re hearing it from Geelong midfielder Travis Varcoe.

Warrnambool’s Gunditjmara Aboriginal Co-operative’s health clinic yesterday enlisted visiting Geelong players to help it target obesity and smoking.

Varcoe, Hamish McIntosh, Joel Hamling and Brad Hartman shared their health and fitness knowledge with a small indigenous audience.

NACCHO Sports Healthy Futures Program

DOWNLOAD THE NEW AFL NACCHO APP and find help /Your nearest AMS 

Find out more about the NACCHO AFL Partnership


All four said they dreamt of playing at the top level from a young age, leaving no place for poor diet or smoking.

“(Footy) is a great driving tool — we could stand there and bat on about healthy eating and get a lot more out of it than a teacher trying to get the same message across,” Varcoe said.

“You don’t realise until you get out there how much joy footy does for people.

“It’s great for us Aboriginal boys to get out here and just meet the community and share a bit of our knowledge with them.”

Co-operative active lifestyle and tobacco action worker Ken Brown said football was a good way to target health changes in young people.

“It’s all ages but it’s starting with the younger ages because teenagers are smoking younger now,” Mr. Brown said.

“Having these blokes here is a big bonus but it is hard. It’s not a quick fix.

“Hopefully we can get it through that smoking will kill you.”

You can hear more about Aboriginal health and Close the Gap at the NACCHO SUMMIT


The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.



NACCHO Healthy Futures Summit Melbourne 24-26 June 2014 : Invitation to submit abstracts


On behalf of the NACCHO Board and Secretariat it is my pleasure to invite you to submit an abstract to the NACCHO Healthy Futures Summit at the Melbourne Convention and Exhibition Centre 24-26 June 2014.



The importance of our NACCHO member Aboriginal community controlled health services (ACCHS) is not fully recognised by governments.

The economic benefits of ACCHS has not been recognised at all.

We provide employment, income and a range of broader community benefits that mainstream health services and mainstream labour markets do not. ACCHS need more financial support from government, to provide not only quality health and wellbeing services to communities, but jobs, income and broader community economic benefits.

A good way of demonstrating how economically valuable ACCHS are is to showcase our success at a national summit.


NACCHO would like to demonstrate to the government at this summit how investing more in ACCHS is the best way of promoting better health more employment, more jobs and greater community economic benefits.


NACCHO Healthy futures Summit-Melbourne 24-26 June 2014

NACCHO invites abstracts submission from its members the Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholder organisations to showcase policy frameworks, best practice and investment in Aboriginal Health.

The delegates will be a representation from all over Australia in clinical practice, policy and research.


Call for Abstracts open 25 February
All Abstracts Due 21 Mar 2014
Abstract Notifications 4 April 2014
Presenter Registration Due 18 April 2014
Early bird registrations open 25 February 2014
Early-Bird registrations Closes 18 April 2014
Program released 4 April 2014
Exhibition and sponsorship 16 May 2014
NACCHO 2014 Summit 24 -26 June 2014

Program Streams

1.Economic Development

  • Economic models of investment  into Aboriginal Community Controlled Health Organisation
  • Economic models of investment through partnership
  • Income generation through Aboriginal Community Controlled Health Organisations
  • Brokerage Modelling with Aboriginal Community Controlled Health Organisation

2.Health Reform

2.1 Workforce

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • National, State, Regional and Local Workforce Needs Analysis
  • Models of success
  • Recruitment and Retention Strategies
  • Mentoring Programs
  • Workforce Innovation Partnership
  • Career pathways that incorporate Scope of Practice within ACCHO’s

2.2 Continuous Quality Improvement

  • Affiliate Registered Training Organisations Capacity Building of ACCHO’s through scope of practice
  • Accreditation
  • Clinical Standards

3.Healthy Futures

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • Clinic Practice/frontline servicing
  • Mental Health
  • Social Emotional Wellbeing
  • Drug & Alcohol
  • Mums & Babies
  • Women’s Health
  • Men’s Health
  • Oral Health
  • Aged Care
  • Disabilities
  • Adolescent
  • Sexual Health


Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • Investment in Youth by Aboriginal Community Controlled Health Organisations
  • Career pathways within an ACCHO, Affiliates and key stakeholders
  • Youth Leadership
  • Mentoring
  • Healthy Lifestyles and Youth
  • Health Promotion Strategies

5.Research & Data

Abstract that demonstrates best practice within Aboriginal Community Controlled Health Organisations, Affiliates and key stakeholders that reflect these themes:

  • Population Health
  • Best practice models
  • Gap and Needs analysis
  • Research within Aboriginal Community Controlled Health Organisations
  • Research Partnerships
  • Health Information
  • Importance of Data
  • Cultural protocols into practice
  • What’s the Aboriginal Community Controlled Health Data telling us?

General guidelines for submissions

  • Abstracts will only be accepted by submitting through the online process below .
  • Abstracts must be a maximum of 300 words .
  • All abstracts must be original work.
  • The abstract will contain text only; no diagrams, illustrations, tables or graphics.
  • All presenting authors must register and pay for their registration for the conference by 18 April 2014 otherwise the presentation will be removed from the program.
  • The NACCHO advisory group reserves the right to accept and reject abstracts for inclusion in the program and allocate to a format that may not have been initially specified by the author/presenter.
  • The conference organisers will not be held responsible for submission errors caused by internet service outages, hardware or software delays, power outages or unforeseen events.
  • It is the responsibility of the presenting author to ensure that the abstract is submitted correctly. After an author has submitted their abstract, they should check their abstract was uploaded successfully.
  • All authors will receive notification of the outcome of their submission on 4 April 2014.
  • Responsibility for the accuracy of abstracts rests with the author.
  • Where there are co-authors, only one abstract is to be submitted. The presenting author is responsible for ensuring the co-authors agree with and are aware of the content before submitting the abstract.
  • An abstract which does not adhere to these requirements will not be accepted


For further information contact the NACCHO SUMMIT TEAM 02 6246 9300 or EMAIL

NACCHO Aboriginal health research:Ten key principles relevant to Aboriginal health research

Male Health Summit - Ross River Resort - July 2013

Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people. In this article, we set out these principles in one short, accessible document

Working with Indigenous communities towards research that is relevant, effective and culturally respectful

Lisa M Jamieson, Yin C Paradies, Sandra Eades, Alwin Chong, Louise Maple-Brown, Peter Morris, Ross Bailie, Alan Cass, Kaye Roberts-Thomson and Alex Brown

Picture above Remote communities Male Health Summit Ross river 2013

As published in the MJA

Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value. As committed Indigenous health researchers in Australia, we reflect Marmot’s ideal – to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live.

As a group, we have over 120 collective years experience in Indigenous health research. Over this time, particularly in recent years as ethical guidelines have come into play, there have been many examples of research done well. However, as the pool of researchers is constantly replenished, we hold persisting concerns that some emerging researchers may not be well versed in the principles of best practice regarding research among Indigenous Australians populations.

Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people. In this article, we set out these principles in one short, accessible document.


 1.Addressing a priority health issue as determined by the community

No group is more aware of the health inequalities between Indigenous and non-Indigenous Australians than Indigenous Australians themselves. Researchers need to work in close partnership with the community so that their own objectives and ideas do not mask the community’s own priority areas. This will require both parties to learn how to work together to manage potentially conflicting agendas, including differences in priority perceptions, community politics and interpretation of findings. The communities and participants need to be engaged as equal partners in all phases of the research process with a flexible agenda responsive to broader environmental demands.

2.Conducting research within a mutually respectful partnership framework

An open and transparent relationship with key community groups is critical to the success of implementing research projects among Indigenous Australians. This can be neither rushed nor faked. Indigenous communities are more likely to embrace working with researchers with whom they have an established rapport than with someone unfamiliar, regardless of the eminence of the researchers, sophistication of the study design or amount of funding available. Researchers should ideally have a commitment to continuing to work with a given Indigenous group (especially if reasonably secure employment opportunities might be possible) following cessation of the study.

In addition, within any given community it is vital to identify key champions for the study and those who are likely to block access. The team of champions might take months or years to foster but their involvement will make an enormous difference in peoples willingness to enrol in and continue with the study. We have learnt (sometimes the hard way) the importance understanding the local “lay of the land” in terms of governance and in working hard to foster open and trusting relationships with those whose support the study’s success will rely on.

3.Capacity building is a key focus of the research partnership, with sufficient budget to support this

Investigators must have a commitment to employ Indigenous staff and provide opportunities for such staff to continue and develop their research careers if at all possible. As well as allowing capacity building of Indigenous staff, this will create substantial learning opportunities for non-Indigenous staff, this will create substantial learning opportunities for non-Indigenous personnel. Different models of employing Indigenous staff may be required in different situations, and partnering with Aboriginal controlled health services can be critical.

Many projects are underfunded. Personnel costs are high and staff turnover might be excessive, more time than anticipated might be required for community engagement, trips may need to be rescheduled, it may take much longer to recruit and unforeseen circumstances (eg, cultural – based delays to the study) are almost certainly guaranteed. It can be difficult to achieve the desired sample size when undertaking research with Indigenous Australians. These issues are not unique to Australia, with other investigations involving Indigenous populations internationally also having been abandoned due to recruiting difficulties. Researchers need to be realistic about these well documented difficulties when planning budgets.

4.Flexibility in study implementation while maintaining scientific rigour

Flexible study implementation may relate to issues such as the need to adjust the planned geographic location, modify eligibility criteria while maintaining scientific rigour, or revise the study protocol based on community feedback. In the United States, many intervention studies among the Native American population have reported no effects, when in fact the lack of results stemmed from poor implementation of the intervention rather than from shortcomings in the intervention itself.

Researchers have suggest that future interventions should “place greater emphasis on the involvement of community members and organizational leaders in the development and implementation of intervention” and that “community –based approach is key to sustainability and acceptability”.

5.Respecting communities past and present experience of research

On one level, the history of Australia’s Indigenous populations – involving forced policies of assimilation, imposed removal of children, profound and sustained social disadvantage, and dislocation from mainstream life – needs to be recognised. In the context of research Indigenous Australians past experience of involvement in research needs to be understood when conducting community consultation in order to foster support and trust. Researchers also have to be ready for communities to say “no” at any point during a study/

Finally, communities have a right to expect that if they agree to be involved in research, it will be of sufficiently high quality and rigour to generate meaningful results and change health outcomes.

Desirable principles

6.Recognising the diversity of Indigenous Australian populations

Although Australia’s Indigenous population represents a small proportion of the total population (2.6% in the 2006 Census), there is great heterogeneity among the many Indigenous groups. This diversity is not such an issue when studies are based within a localised geographic area (although even in small geographic areas the differences may be greater than appreciated), but needs to be carefully planned for when implementing research (such as national population-level surveys) that may include many different language and culturally distinct groups.

7.Ensuring extended timelines do not jeopardise projects

In our collective experience, timelines for conducting research with Australian Indigenous groups sometimes need to be extended. Reasons include delays in obtaining ethical approvals (many studies require formal approval from Aboriginal human research ethics committees, which frequently require written letters of support from key Indigenous stakeholder groups); delays and interruptions to community consultation sessions; delays to interviewing and employing local community members as staff ; unforeseen community – based events (eg, funerals community meetings, council or health service instability).

The need for longer recruitment times’ unforeseen weather events; and difficulties in securing appropriate travel and accommodation. In addition, the myriad demands placed on Indigenous communities and their members require research to “wait its turn”. Projects that have run on time and within budget have usually taken account of these challenges in the planning stages.

8.Preparing for Indigenous leadership turnover

Leadership turnover among key Indigenous stakeholder groups can be high. This occurs at both high-end governance and grassroot community levels. There is enormous, often unreasonable, pressure placed on many Indigenous Australians in leadership, both from within their own communities and from mainstream structures.

Non-Indigenous researchers would do well to anticipate this in advance rather than rely on a small number of key Indigenous leaders to promote and advocate their study. Indigenous advisory committees are invaluable in offering further advice on this issue, as are local Aboriginal ethics committees and community – controlled health organisations. Maintaining close and trusting relationships with a number of local Indigenous leaders (and recognising that these may take years to establish) may help researchers prepare for such occurrences.

9.Supporting community ownership

In the past, the rights interests and concerns of Indigenous participants were frequently ignored by non-Indigenous participants were frequently ignored by non-Indigenous researchers. We now know that the sustainability of research projects is achieved only when there has been substantive community input and ownership.

From the outset, research projects need to be directed by the relevant Indigenous communities, by forming Indigenous advisory committees where possible, and by researchers constantly reviewing their study goals ideal, membership of advisory or steering committees can place a substantial burden and expectation on the relatively small number of people who have the time, interest and skills to sit on them, If it is not possible to form such a committee, the role of Indigenous staff and Indigenous community members becomes even more critical.

10. Developing systems to facilitate partnership management in multicentre studies

Investigations involving Indigenous Australians are becoming increasingly multicentre, both within Australia and with International collaborators. Ensuring that equitable and transparent processes are in place for managing partnerships, community engagement and recruitment, ethics, intervention implementation, use of new technologies, and compliance with privacy requirements is critical for the wellbeing of both study participants and the wider research community.


These 10 principles should be considered from the initial design stage of the project, ideally when consulting with the community and writing funding applications”

This may have policy implications for funding bodies, as substantially more funding will likely be necessary to ensure that specific principles can be followed – eg, regarding capacity building (3) and extended timelines (7). Application of the principles should not affect the accurate reporting of trials using tools such as the Consolidated Standard of Reporting Trials. The principles support, and could be considered in harmony with existing NHMRC ethics guidelines.

Most of the principles have been reported before with respect to research involving marginalised peoples, Indigenous Australians, other Indigenous peoples and the general population. They should also be seen in their broad context – We believe that the 10 principles are relevant to all Indigenous health- related research. If considered, they may, in a small way, help research projects among Indigenous Australians be implemented in the most effective and culturally respectful way possible.


NACCHO needs to improve how we  connect, inform and engage into the Ifuture.


Please Take

NACCHO health alert: Report documents Aboriginal people are 50 per cent more likely to die from cancer than other Australians


Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview is one of a series of reports commissioned by Cancer Australia and developed in collaboration with the Australian Institute of Health and Welfare.



This report provides, for the first time, a comprehensive summary of population-level cancer statistics across a number of states and territories in Australia for Aboriginal and Torres Strait Islander peoples alongside comparative figures for non-Indigenous Australians

. It aims to document key cancer statistics to inform health professionals, policy makers, health planners, educators, researchers and the broader public of relevant data to understand and work towards reducing the impact of cancer for Indigenous Australians.

On average, per day, around two Aboriginal and Torres Strait Islander people are diagnosed with cancer and there is just over one cancer-related death.


Importantly, this report identifies significant differences between Indigenous Australians and their non-Indigenous counterparts. While incidence rates for cancer overall were marginally higher for Indigenous peoples, mortality and survival differences between the two population groups were more marked with cancer mortality rates 1.5 times higher and survival percentages 1.3 times lower for Aboriginal and Torres Strait Islander peoples.

This report also looks at the 10 most commonly diagnosed cancers as well as the 10 most commonly reported causes of cancer deaths for Aboriginal and Torres Strait Islander peoples of Australia, accounting for over 60% of cancers in these groups. Lung cancer was both the most commonly diagnosed cancer and the leading cause of cancer deaths for this population group. Differences between gender and across age groups are also identified.

Transcript of the ABC interview:

In a recent interview on ABC’s , Mark Colvin discussed findings from the Australian Institute of Health and Cancer Australia which indicates that Indigenous people are 50 per cent more likely to die from cancer than other Australians.

MARK COLVIN: It may be the most deadly reality of closing the gap: Indigenous people are 50 per cent more likely to die from cancer than other Australians. And that’s just one of the shocking findings contained in a new report from the Australian Institute of Health and Welfare and Cancer Australia. It’s the first comprehensive investigation into increased cancer rates among Indigenous Australians.

MANDIE SAMI: Cancer in Aboriginal and Torres Strait Islander Peoples of Australia: An Overview is the first comprehensive summary of cancer statistics for Indigenous Australians.

The head of the Australian Institute of Health and Welfare’s cancer and screening unit, Justin Harvey, says the report reveals disturbing facts.

JUSTIN HARVEY: Indigenous Australians are approximately 50 per cent more likely to die from cancer than non-Indigenous Australians and that’s quite a big difference between the two. The rate of new cases for Indigenous Australians is also higher and survival from cancer is poorer.

MANDIE SAMI: Kristin Carson is the chair of the Indigenous Lung Health working party for the Thoracic Society of Australia and New Zealand. She says it’s sad that she’s not shocked by the findings.

KRISTIN CARSON: This is something that has been going on for such a long time. I mean, we know that there is a disparity in health between Indigenous and non-Indigenous Australians. It’s actually atrocious.

A lot of Aboriginal and Torres Strait Islander Australians who see this probably already know it. They live this. This is the reality and I guess it’s these types of more shocking statistics that bring the kind of problems that we’re having to light.

MANDIE SAMI: The CEO of Cancer Australia, Professor Helen Zorbas, says there are a number of reasons why there’s such a huge discrepancy between Indigenous and non-Indigenous Australians.

HELEN ZORBAS: Those factors definitely include tobacco smoking, alcohol consumption, poor diet, lower levels of physical activity and higher levels of infections such as hepatitis B. In addition to that, Indigenous peoples are less likely to participate in screening programs.

Also, the proportion of Indigenous people who live in regional and rural and remote areas is higher than for non-Indigenous people and therefore access to care and services – we have a higher proportion of Indigenous people who discontinue treatment.

MANDIE SAMI: The head of the Institute’s cancer and screening unit, Justin Harvey, says even the types of cancer most prevalent among Indigenous Australians are different.

JUSTIN HARVEY: In terms of the most commonly diagnosed cancers for Indigenous Australians, these were lung cancer, followed by breast cancer in females and bowel cancer. Whereas for non-Indigenous Australians, the most commonly diagnosed were prostate cancer, followed by bowel cancer and breast cancer in females.

MANDIE SAMI: Mr Harvey says the report shows there needs to be more health promotion campaigns and services targeting Indigenous Australians.

JUSTIN HARVEY: The most important thing is that the information is used in looking at what are the needs and how best to address those needs.

MANDIE SAMI: That call has been backed by Kristin Carson. She says there’s also a need to evaluate whether current campaigns like these are working.

ACTOR, ANTI-SMOKING AD: I was smoking but I quit. If I can do it, I reckon we all can.

ACTOR 2, ANTI-SMOKING AD: Not quitting is harder.

MANDIE SAMI: Ms Carson says all Australians have a moral obligation to ensure that improving the health of Indigenous Australians is a national priority.

KRISTIN CARSON: Talk with community members, find out what we should be doing, and again, it highlights that we really need to be looking at research or evaluations in this area to try and better address this problem.

MANDIE SAMI: Associate Professor Gail Garvey is a senior researcher in cancer and Aboriginal and Torres Strait Islander Health at the Menzies School of Health.

She hopes the findings will make policymakers realise the devastating effect cancer is having on Indigenous populations.

GAIL GARVEY: Other areas, you know, such as cardiovascular disease, diabetes, kidney disease, which are all very important in their own right, tend to get the sort of focus, where cancer has just been sort of creeping behind all the other illnesses and diseases thus far.

So I think this report will give us a chance and give governments and health professionals and communities an opportunity now to actually look at what’s happening, you know, in black and white in this report, what’s happening nationally. And hopefully we can do something more about it than what’s currently being done.

MARK COLVIN: Associate Professor Gail Garvey, ending Mandie Sami’s report

For more information visit the ABC’s 2pm website



NACCHO Smoke Free news: Stickin’ It Up The Smokes – has there been a catchier campaign name?

photo (6)

The recent NACCHO Summit had a number of presentations about different tobacco control projects that are underway across the country.

While their goals differ, they all are harnessing new technologies and online communications channels, reports journalist John Thompson-Mills.


Tobacco control projects in the spotlight 

John Thompson-Mills writes:

Tablets are being used to survey Aboriginal and Torres Strait Islander people and the staff and clients of community controlled services about smoking-related issues.

The Talking About the Smokes project aims to better understand the pathways to smoking and quitting for Aboriginal and Torres Strait Islander people, and to evaluate what works in helping them to quit smoking. (Many organisations are involved in the project, as outlined here).

So far, more than 2400 Aboriginal and Torres Strait Islander people have completed the first wave of the survey, which has seen health workers and even community Elders involved in collecting the data, using tablet technology.

Vouchers to supermarket and other major shopping chains are also used as inducements to encourage participation. A second wave of the survey is about to begin.

Jamahl, a Townsville health-worker, has been smoking since he was sixteen. He’s been convinced quitting is a good idea since recently losing a dearly loved Aunty to cancer.

Jamahl has taken the survey, and was surprised about what he learnt.

He says it’s made him think differently about his community and is convinced other respondents will feel the same way.


Making it Work

In NSW, more than 1000 “Tobacco Resistance Toolkits” have been downloaded since the Australian Health & Medical Research Council launched “Making It Work” in October last year.

Aimed at new Aboriginal service providers who lack training or culturally appropriate resources, the Tobacco Resistance and Control team (ATRAC) toolkit is a series of three modules.

These offer a practical template for data collection, creating a smoke-free workplace policy and how to source current facts and figures, called “Let’s Get Started.” A fourth module, Social Marketing, is about to be launched.

The three-year program has placed no limit as to how many modules will be available to its service providers. The more the community needs, the more consultation-based modules will be developed.

Once again, the community will shape and drive the program.

Jasmine Sarin who presented the seminar at the NACCHO Summit said defining success won’t be about the Toolkit’s effect on smoking prevalence.

“It’s more about measuring how people move through stages of change,” she says. “So, not smoking in the home anymore, or no longer smoking around children, any improvements in those areas would represent a success for us.”


Stickin’ It Up The Smokes

In South Australia, a unique program IS looking to reduce smoking prevalence – among young pregnant Aboriginal women.

In SA, the smoking rate for pregnant women is three times higher for Indigenous women than non-Indigenous women, totalling nearly 53%.

South Australia also has the highest number of low birth-weight babies.

The answer is Stickin’ It Up The Smokes, put together by the Aboriginal Health Council of South Australia (AHCSA).

Using social media, a series of flyers, posters and regional radio ads, a multi-faceted campaign has been pulled together in very quick fashion and for very little cost.

Mary Anne Williams, the Maternal Health Tackling Smoking Program Officer at AHCSA, says her initial campaign costs were heading towards $20,000.

But by bringing in a number of Aboriginal media students and finding a young social marketing expert, the final outlay was a fraction of that, at $2,000.

Speaking at the NACCHO Summit, Williams said the campaign only took four months to go from concept to delivery; a massive eight months quicker than a Government-led process would have taken.

She even managed to get some help from X-Factor finalist Ellie Lovegrove who wrote a rap for the campaign.

There were some challenges though. Convincing some community Elders about the merits of the strategy took time. And it was a struggle to find the nine non-smoking ambassadors until a Facebook campaign was launched. Then the quota was filled within two days.

The target audience is primarily pregnant SA Aboriginal women aged in their early 20s.

The secondary targets include: Aboriginal mothers with young babies, especially those who are breastfeeding; families, and particularly partners, of pregnant Aboriginal women; young Aboriginal women who have not yet taken up smoking or had children (especially those aged 10-14 years); and Aboriginal communities throughout South Australia.

The aim of the Stickin It Up The Smokes campaign is modest:  a 2.1% per year reduction in smoking during pregnancy for Aboriginal women by June 2016.

The Summit also heard yesterday about anti-smoking efforts by the Kimberley Aboriginal Medical Services Council, in WA. Some tweet reports follow.

NACCHO team member news: Arika Errington’s 10-year journey to become a University graduate is a story of true perseverance.

Faculty of Arts & Design and Faculty of Business, Government & Law Graduation Sept 2013

NACCHO team member Arika Errington’s 10-year journey to become a University of Canberra graduate is a story of true perseverance.

An Aboriginal woman who grew up in Canberra, Ms Errington graduated with a Bachelor of Arts after having been diagnosed with depression and anxiety while studying and moving from Queensland to Tasmania and Melbourne before settling back in Canberra.

“It doesn’t quite feel real, I also feel relieved … it was a rough 10 years of starting, leaving, changing disciplines, illness, and self doubt,” Ms Errington said of graduating in a ceremony at Parliament House on 25 September.

“My aim is to one day be a voice for my people, to teach others about who we are as a community and the oldest living culture on earth … I want to change the assumptions/judgements people automatically make about Aboriginal people rather than judging them on their actions as human beings.”

Article Krystin Comino
Arika Errington pictured at her University of Canberra graduation ceremony at Parliament House. Photo: Michelle McAulay

The 29-year-old said she was “proud to even be offered the opportunity” to go to the University, majoring in journalism to follow in the footsteps of her father, William Errington, a former press photographer. Her mother Tjanara Goreng Goreng is an assistant professor at the University’s Ngunnawal Centre, which provides support and education programs for Indigenous students.  Ms Errington said she has been inspired by her parents.

“I’m only attending my graduation so my mum and dad can see. I did it all for them, they have given me nothing but love and respect my entire life, whilst dealing with their own personal traumas,” she said.

“My mob are called the Wakka Wakka and Wulli Wulli people from Queensland and I’ve always known my culture growing up, my parents both made sure I knew who I was and where I was from, my mum used to sing me songs in language and I hope one day I’m blessed enough to share those to my children so some of our language can continue.”

Ms Errington moved to Queensland for a while in her teen years before her mother encouraged her  to do the Ngunnawal Centre’s foundation program to prepare her to study at the University of Canberra, a program she later ended up teaching in, saying “all I wanted was to help students who were like me succeed”.

Despite calling Canberra home, Ms Errington has moved around a lot in her life, including living in a rainforest at a place called Main Arm Upper in NSW.

“We lived on the land without electricity, running water, and a makeshift toilet out the back, checking myself for leaches and ticks at the end of each day.”

Moving back to Canberra to start her studies, she took a break from university to work in Melbourne for a few years before returning to the University of Canberra, where she spent some time living on campus.

“I had no idea what I wanted to do, but I knew I wanted to finish something I started. I completed a literature class but I was really unhappy (I eventually was diagnosed with depression/anxiety which I didn’t know about at the time) and moved to Tasmania where my mum was working at a university to have a break and be with my family,” she said.

“I then moved to Melbourne in 2005 and started a job, got my own place, and began finding out who I was and who I wanted to be, then in 2006 I woke up one day and decided to leave behind my life in Melbourne, and finish uni.”

Since 2012 she has worked in the National Aboriginal Community Controlled Health Organisation as a project coordinator on the ‘Talking About the Smokes’ research project – designed to help Indigenous people quit smoking – in partnership with Menzies School of Health Research in Darwin.

“I’m extremely grateful to have been given this opportunity because it has helped me grow as a person, and understand my true value, and also I get to show other Aboriginal people how to gather data for our project, the youngest I’ve trained to be a research assistant was 17, and the eldest 72, it’s really helping our communities and mob and showing them that anything is possible, no matter where you live or how old you are, it’s been great seeing different communities, community control at its finest.”

She also recently began a communications officer position with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), allowing her to draw on her journalism skills.

“I really respect what CATSINaM does for our people and for the Indigenous health sector and I enjoy being a part of two National Aboriginal and Torres Strait Islander peak bodies.”

She was also recently awarded a scholarship to attend the ‘She Leads’ program run by the YWCA of Canberra in a Diploma of Management with leadership as a main focus.

There are over 155 Aboriginal or Torres Strait Islander students currently studying at the University


NACCHO JOB Opportunities:

Are you interested in working in Aboriginal health?

NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.

Register your current or future interest with our HR TEAM HERE

NACCHO Smokefree news: Governments can’t make people healthy; we have to do it ourselves.”

World No Tobacco Day event

“In some of our communities smoking rates are higher, 80 per cent plus,” says Aboriginal elder and social rights campaigner, Dr Tom Calma AO. ( Pictured above left with NACCHO chair at our World No tobacco day in May)

“We’ve got a target to halve the smoking rate by 2018.”

People need to make informed decisions about their own health. Governments can’t make people healthy; we have to do it ourselves.”

Nearly three-quarters of Australian men and over a quarter of Australian women smoked in 1945.

Today, public health initiatives have helped reduce the number of smokers to around 17 per cent of the general population.

However, 47 per cent of Indigenous and Torres Strait Islanders are still smoking.

“In some of our communities it’s higher, 80 per cent plus,” says Aboriginal elder and social rights campaigner, Dr Tom Calma AO. “We’ve got a target to halve the smoking rate by 2018.”


Calma is leading the charge as the National Co-coordinator for the Tacking Indigenous Smoking program, which he will be speaking about in his keynote address at the Commitment to Indigenous Health: Local and National Contributions to Meeting the Challenges conference this Wednesday.

“The Commonwealth Government has devoted $106M over four years to establish a work force across the nation to go out — outside of the clinical setting and into the community — to inform people about the hazards of smoking and the benefits of not smoking.”

Regional Tackling Smoking & Healthy Lifestyle Teams in 57 regions across the nation are working with smokers to help them kick the habit, and also with non-smokers to ensure they don’t start.

A far cry from the campaigns of shocking images and heartbreaking stories, Calma and his teams are approaching the problem from a different angle.

“My teams don’t always talk about the negative aspects of smoking; they put a positive spin on it,” says Calma.

“If you don’t smoke you are going to be healthier, you’re going to save money — up to $6000 a year for a pack a day smoker. And with that money you could then take your family on a holiday. The average pack a day smoker smokes the equivalent of four return air tickets to Los Angeles a year.”

“When we give them information in a way that’s non-threatening and they can understand, they respond.

“People need to make informed decisions about their own health. Governments can’t make people healthy; we have to do it ourselves.”

Dr Tom Calma AO is speaking at the Commitment to Indigenous Health: Local and National Contributions to Meeting the Challenges conference on Wednesday 2 October.

Indigenous Health Interest Group Research Showcase

Indigenous Health Interest Group & the Australian Institute of Aboriginal and Torres Strait Islander Studies

Wednesday, 2 October 2013 from 9:00 AM to 5:00 PM (EST)

Registration is free and open to the public.


NACCHO JOB Opportunities:

Are you interested in working in Aboriginal health?

NACCHO as the national authority in comprenhesive Aboriginal primary health care currently has a wide range of job oppportunities in the pipeline.

Register your current or future interest with our HR TEAM HERE

NACCHO Deadly Health Awards alert:Rewrite your story campaign excellence in health promotion


The chair of NACCHO Justin Mohamed today congratulated the partnership of Nunkuwarrin Yunti of South Australia Inc,the Aboriginal Health Council of SA, Port Lincoln Aboriginal Health Service, and the Cancer Council SA for the Rewrite Your Story campaign that was honoured with the  Excellence in Health Through the Promotion of Healthy and Smoke Free Lifestyles Award at the 19th Deadlys®

The Rewrite Your Story campaign, developed by the Puiyurti team at Nunkuwarrin Yunti of South Australia Inc, embraces the culture of story-telling and yarning through the power of film and social media.


Rewrite Your Story is a community development campaign aiming to raise awareness of smoking’s harmful effects on your body and community.

The campaign featured the real-life smoking stories of 16 local ambassadors to inspire Adelaide’s Aboriginal communities to rewrite their stories and give up smokes for good.

The campaign doesn’t preach the ‘don’t smoke message’, but encourages the community to come together, share their stories and support one another to break the smoking cycle.

It was supported by the South Australian Government’s Give Up Smokes for Good campaign in partnership with the Aboriginal Health Council of SA, Port Lincoln Aboriginal Health Service, and the Cancer Council SA.

The campaign has been well received by the Aboriginal community of Adelaide and has been widely covered in media, as well as being picked up by NITV who have committed to showing these stories over the next three years.

This is the first year the Excellence in Health Through the Promotion of Healthy and Smoke Free Lifestyles has been awarded and it is proudly supported by the Wellington Aboriginal Corporation Health Service (WACHS). Wellington Aboriginal Corporation Health Service (WACHS) aims to empower Aboriginal and Torres Strait Islander people to take control of their individual, family and community health needs through the Aboriginal community controlled health service model.

WACHS is a non-for-profit organisation that provides specific health and specialist programs to support clients/ patients in addressing their health and well-being needs and issues in a culturally appropriate way. As well as providing these specific health related services, our service endeavours to provide self-determination and empower Aboriginal people to take control and responsibility for their health and well-being.

Vibe Australia produces the Deadlys®, Vibe 3on3®, InVibe, Deadly Vibe®, Deadly Sounds and Deadly TV. The Deadlys® 2013 will air on SBS ONE on Sunday 14 September at 9.30pm and repeated on NITV on Wednesday 18 September at 9.30pm.

You can keep up to date with all the Deadlys® news at and through Twitter @Deadly_Vibe #deadlys. You can also head to and subscribe to Deadly Vibe Wire at

NACCHO smoking health news: How will we close the gap in smoking rates for pregnant Indigenous women?

Megan E Passey, BMed(Hons), MPH, MSc, Deputy Director — Research1

Jamie Bryant, PhD, BPsych(Hons), ARC Postdoctoral Research Fellow, School of Medicine and Public Health2
Alix E Hall, BPsych(Hons), PhD Candidate, Priority Research Centre for Health Behaviour2
Robert W Sanson-Fisher, PhD, ClinMPsych, BPsych(Hons), Laureate Professor of Health Behaviour, School of Medicine and Public Health2
1 University Centre for Rural Health — North Coast, University of Sydney, Sydney, NSW.
2 University of Newcastle, Newcastle, NSW.
  • Aboriginal and Torres Strait Islander women are more than three times more likely to smoke during pregnancy than non-Indigenous women, greatly increasing the risk of poor birth outcomes.

  • Our systematic review found that there is currently no evidence for interventions that are effective in supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking, which impedes development and implementation of evidence-informed policy and practice.

  • There is an urgent need for methodologically rigorous studies to test innovative approaches to addressing this problem.

Antenatal smoking is the most important modifiable cause of adverse pregnancy outcomes.1 Indigenous Australian women are more than three times more likely to smoke during pregnancy than non-Indigenous women.2 As a result, adverse outcomes are more frequent in Indigenous than non-Indigenous babies, with smoking as an independent risk factor.3

Reviews of antenatal smoking interventions have shown effective cessation strategies for pregnant women.1 However, persistently high rates of smoking during pregnancy among Indigenous women suggest that current interventions have had limited impact. Finding ways to effectively reduce smoking in pregnant Indigenous populations is a high priority. Previous systematic reviews have examined smoking cessation interventions for Indigenous peoples; however, none has specifically investigated smoking cessation among pregnant Indigenous women.4,5

We undertook a systematic review to examine the effectiveness and methodological quality of smoking cessation interventions targeting pregnant Indigenous women. In December 2012 we searched MEDLINE, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Cochrane databases with appropriate search terms, and checked reference lists of retrieved articles. Papers were included if they reported a smoking cessation intervention aimed at pregnant Indigenous women, included a control group and provided cessation results specifically for pregnant Indigenous women. Only peer-reviewed, English-language papers were included. We extracted data and assessed methodological quality against Effective Practice and Organisation of Care quality criteria.6

Of 59 identified papers only two met eligibility criteria: one from the United States with Alaskan Native women,7 and one from Australia with Aboriginal and Torres Strait Islander women.8 Both involved culturally tailored interventions specifically developed for the target group, and used face-to-face counselling, structured follow-up, attempts to involve family members and nicotine replacement therapy (NRT). Both studies found no treatment effect and had a number of limitations (Box).

This lack of evidence of effective smoking cessation interventions for pregnant Indigenous women prevents implementation of evidence-based programs and highlights a critical need for methodologically rigorous testing of possible strategies.

What interventions should we test?

Evidence from research with Indigenous populations, and with pregnant women generally, provides guidance about the strategies that hold promise for pregnant Indigenous women. These strategies are outlined as follows.

Tailor interventions to local culture

Interventions for Indigenous people need to be culturally secure and locally tailored in order to increase acceptability and accessibility.4,5,9 Involving local people in developing and tailoring intervention resources to the local context is critical for improving cultural appropriateness, building ownership and enhancing a sense of autonomy, all of which are important in successful cessation.10

Include routine assessment and support

Smoking cessation guidelines for pregnant women recommend a systematic approach to cessation where every woman is asked about her smoking status, with smokers followed up and supported to quit in a respectful manner.11 Health professionals may be reluctant to repeatedly assess smoking status due to concerns that it may be deleterious to their relationship with women and the women’s engagement with care.9,1214 However, most Indigenous women expect antenatal care to include smoking cessation advice.15 Systems to support routine assessment and support should be included in intervention trials.

Provide relevant information

Indigenous women’s knowledge of specific risks of smoking while pregnant is often vague.9,15,16 Providing information on the harms of smoking and benefits of cessation may motivate some women to attempt to quit. Discussing the woman’s role as a mother and a role model for her family may be more motivating for some Indigenous women than health risk narratives and should be addressed in intervention trials.

Deliver cessation support through all antenatal providers

Overall, 78% of Indigenous women attend five or more antenatal visits during their pregnancies.2 Providing cessation support through routine antenatal care overcomes barriers to attending separate services.13 A collaborative approach between midwives, Aboriginal Health Workers (AHWs) and doctors, all providing consistent advice and support, will reinforce the importance of cessation. The credibility of medical practitioners may be a significant motivating factor for some women. In cases where midwives provide much of the care, the close relationship and frequent contact allows ongoing support. AHWs’ cultural knowledge and strong links with local families will enhance implementation of cessation support.14 In a survey of Indigenous women, over 70% of women felt that support from these professionals was likely to be helpful.17

Involve other members of the community

The high prevalence of smoking in Indigenous communities has resulted in smoking being “normalised” as a socially acceptable behaviour, with frequent triggers to smoke and cigarettes being readily available.9,16,18 Smoking is important in social relationships, and cessation can lead to feelings of isolation.18,19 Supportive environments for quitting have aided cessation among Indigenous ex-smokers.10 Trialling interventions that incorporate mechanisms to provide a supportive, pro-cessation environment, such as involving household members in supporting women, peer support groups and whole community interventions should be further explored.20

Address relapse

Interventions that incorporate strategies to prevent smoking relapse result in fewer women relapsing in late pregnancy.1 Up to 80% of women who quit during pregnancy relapse within 1 year.21 Specific relapse prevention support should be provided during pregnancy and postpartum, including information about the effects of environmental tobacco smoke on the baby, support to make a smoke-free home and support for household members to quit smoking.21 Relapse prevention strategies have not been examined among Indigenous women and should be included in future trials.

Use contingency-based financial rewards

Systematic reviews of antenatal smoking cessation interventions have found that financial rewards contingent on successful smoking abstinence are significantly more effective than other interventions.1 However, their efficacy with Indigenous women has not been tested. Australian surveys indicate that contingency-based rewards are considered likely to be helpful by over 90% of Indigenous women and 83% of their antenatal providers.17,22 This approach should be further explored with Indigenous women.

Other substances

Surveys of pregnant Indigenous women found that tobacco smokers were more than three times more likely than non-smokers to report cannabis or alcohol use, both of which are risk factors for continued smoking.17 Given the known negative impact of these substances on birth outcomes and the interaction between their use and use of tobacco, interventions should include explicit assessment of other substance use, with support to address these if required.11

Training providers

A lack of protocols and poor smoking cessation support skills have been identified as barriers to providing cessation support to pregnant Indigenous women.12 Well defined protocols detailing specific procedures, and the role of each provider, may assist in increasing provision of support in routine care.13 Training should cover skills in smoking cessation support, supportive communication and using protocols, as well as recording women’s smoking status, cessation behaviour and support provided, to facilitate consistent advice from all team members.

Possible challenges

Conducting complex behavioural intervention trials is difficult. Potential challenges include:

Random allocation

As smoking cessation support is provided at both the service and individual level, randomisation at the individual level is inappropriate as contamination between groups is likely. Cluster randomised controlled trials with randomisation of dispersed services may reduce this problem but require larger sample sizes and more participating services, increasing costs and logistics challenges. As services and communities may not be willing to be randomly allocated to “usual care”, it may be more appropriate to undertake a head-to-head comparison of two approaches considered likely to be effective.23

Adherence to protocols

Poor adherence to intervention protocols may occur as a result of unsuitable intervention requirements, inadequate staff training, high staff turnover and lack of systems to support the intervention. Smoking among AHWs has also been identified as a potential barrier to implementation and would need to be addressed as part of the intervention.14,16 Strong organisational support for the implementation and evaluation of strategies is critical to supporting adherence. Collaborative development of the intervention and study design with Indigenous services and pilot studies to assess acceptability and feasibility of the research will help successful implementation.


Given the importance of finding effective strategies to decrease smoking among pregnant Indigenous women, and the current lack of evidence to guide this process, there is an urgent need for rigorous studies to test innovative approaches. While there are many challenges in this research, these may be managed with existing methods for testing complex interventions in diverse settings.24 Without an evidence base, we risk implementing ineffective strategies, failing to improve outcomes and wasting scarce resources.