NACCHO Overcoming Indigenous Disadvantage #Smoking and Healthy Lives report : Cigarettes favoured over fruit in Outback stores

 

smokes 
” Between 2001 and 2014-15, the crude daily smoking rate for Aboriginal and Torres Strait Islander adults declined from 50.7 to 41.4 per cent (table 8A.4.1).

  A similar decline in non-Indigenous smoking rates meant that the gap in (age-adjusted) daily smoking rates remained relatively constant at around 26 percentage points between 2001 and 2014-15 (table 8A.4.7).

There is no published robust evaluation of an intervention resulting in a decrease in the prevalence of tobacco smoking for Aboriginal and Torres Strait Islander people (Minichiello et al 2016). “

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” Tobacco turnover had remained “consistently high” with 8.34 million sticks sold over the year and tobacco accounting for 19 per cent of all food and grocery sales.

Customers spent 4.4 times more on cigarettes than fruit and vegetables in 2015/16.”

Chairman Stephen Bradley revealed in the annual report of Outback Stores Pty Ltd, the government-owned company which manages 37 businesses in some of the remotest parts of Australia.

Lung cancer is the highest-ranked cancer type among Indigenous people, but the fourth-ranked for non-indigenous Australians.

An incentive program to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales.

 Location of Outback stores across Australia.

Location of Outback stores across Australia.

But the company admitted more needed to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” Mr Bradley wrote.

The government is aiming to close the gap between Indigenous and non-indigenous life expectancy within a generation, halving the gap in mortality rates for under-fives within a decade and halving the gap in employment outcomes.

The company reported 297 Indigenous staff were employed in Outback Stores businesses, which turned over $82.5 million in 2015/16.

Overcoming Indigenous Disadvantage: Key Indicators 2016

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–>The Overcoming Indigenous Disadvantage report measures the wellbeing of Aboriginal and Torres Strait Islander Australians. Chapter 8.4

Tobacco consumption and harm[1]

Things that work

There is no published robust evaluation of an intervention resulting in a decrease in the prevalence of tobacco smoking for Aboriginal and Torres Strait Islander people (Minichiello et al 2016).

A systematic review of 73 interventions in indigenous communities globally found that there was no single intervention that was more likely to result in a reduction in tobacco use, but rather that more successful programs:

  • use a comprehensive approach inclusive of multiple activities
  • centre Aboriginal leadership
  • make long-term community investments
  • provide culturally appropriate health materials and activities to produce desired changes (Minichiello et al. 2016).

Research from the national Talking About The Smokes project also highlighted the importance of taking a comprehensive approach to tobacco control, reporting that a broad range of factors were associated (positively and negatively) with the desire by Aboriginal and Torres Strait Islander smokers to quit (Nicholson et. al 2015).

Box 8.4.1      Key messages
·      Between 2001 and 2014-15, the crude daily smoking rate for Aboriginal and Torres Strait Islander adults declined from 50.7 to 41.4 per cent (table 8A.4.1).

·      A similar decline in non-Indigenous smoking rates meant that the gap in (age-adjusted) daily smoking rates remained relatively constant at around 26 percentage points between 2001 and 2014-15 (table 8A.4.7).

 

Box 8.4.2      Measures of tobacco consumption and harm
There is one main measure for this indicator (aligned with the associated NIRA indicator), rates of current daily smokers, measured by the proportion of people aged 18 years and over who are current daily smokers (all jurisdictions; remoteness; age; sex).

Smoking rate data are available from the ABS Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS)/National Aboriginal and Torres Strait Islander Social Survey (NATSISS), with the most recent data available from the 2014‑15 NATSISS. Data for the non‑Indigenous population are sourced from the ABS Australian Health Survey (AHS)/National Health Survey (NHS), with the most recent data available from the 2014-15 NHS.

Previous editions of this report included a supplementary measure on tobacco-related hospitalisations. This is no longer included as the measure only related to conditions directly attributable to tobacco — not most conditions, where tobacco may be a contributing factor but the link is not immediate. Data are also difficult to interpret as they represent less than one per cent of all Aboriginal and Torres Strait Islander hospitalisations and are therefore highly volatile over time.

Tobacco consumption is a subsidiary performance measure for COAG’s target of ‘closing the life expectancy gap (between Indigenous and non-Indigenous Australians) within a generation’ (COAG 2012).

In Australia, up to two-thirds of deaths in current smokers can be attributed to smoking (AHMAC 2015). Among Aboriginal and Torres Strait Islander Australians, tobacco use is the leading risk factor contributing to disease and death (Vos et al. 2007). Studies have found that smoking tobacco increases the risk of developing numerous cancers, heart and vascular diseases, and depression (AHMAC 2012; Cunningham et al. 2008; Pasco et al. 2008). Smoking in pregnancy can lead to miscarriage, stillbirth or premature birth (Graham et al. 2007). Section 6.2 includes information on women reporting smoking during pregnancy.

Compared to non-Indigenous people, Aboriginal and Torres Strait Islander Australians who smoke generally commence at an earlier age and smoke for longer (CEITC 2010, 2014). Recent research (Knott et al. 2016) suggests also there may be fundamental differences in the determinants of smoking and the reasons for quitting, between Aboriginal and Torres Strait Islander men and women.

Research has found that the proportion of Aboriginal and Torres Strait Islander adults who want to quit smoking and those who have made a quit attempt in the past year, are similar to the general population. However fewer Aboriginal and Torres Strait Islander adults have made a sustained quit attempt for at least a month and a lower proportion agree that social norms disapprove of smoking, compared to the general population (Thomas et. al 2015).

Tobacco use is often associated with other lifestyle related health risk factors, such as excessive alcohol consumption and poor diet. Long term risky/high risk drinkers (both males and females) were more likely to be current smokers than those who drank at a low risk level (ABS 2006). Section 11.1 examines alcohol consumption and harm.

In Australia and many other countries smoking behaviour is inversely related to socioeconomic status, with those in disadvantaged groups in the population more likely to start and continue smoking. In addition to long-term health risks, low income groups (such as some Aboriginal and Torres Strait Islander families and communities) are affected by the financial strain associated with tobacco use (Greenhalgh 2015). A recent study in NSW found that more disadvantaged areas were significantly more likely to have higher tobacco outlet densities, with this density significantly and positively associated with smoking status (Marashi-Pour 2015).

Tobacco consumption

Current daily smokers are people who smoked one or more cigarettes (or pipes or cigars) per day at the time of survey interview.

The COAG performance measure and the data presented in this section focus on the proportion of people aged 18 years and over who are current daily smokers. However, as noted, Aboriginal and Torres Strait Islander Australians tend to start smoking at an earlier age than non‑Indigenous people — for 2014-15, in non-remote areas around one in six (16.2 per cent) Aboriginal and Torres Strait Islander 15 to 17 year olds were current daily smokers, compared with one in thirty (3.3 per cent) non‑Indigenous 15 to 17 year olds (table 8A.4.12).

Nationally in 2014-15, the crude daily smoking rate among Aboriginal and Torres Strait Islander adults was 41.4 per cent, a decline from 50.7 per cent in 2001 (table 8A.4.1). Rates varied across states and territories in 2014-15, from 38.8 per cent in SA to 46.2 per cent in the NT (table 8A.4.1). Smoking rates were higher in remote and very remote areas (49.3 per cent and 48.9 per cent) than in major cities (36.3 per cent) (table 8A.4.2). In non-remote areas in 2014-15, smoking was most prevalent among those aged 25–54 years (between 45.4 and 46.5 per cent), with smoking rates much lower for older people (31.3 per cent for those aged 55 years and over). A similar pattern was observed for non‑Indigenous Australians, although the daily smoking rates were consistently lower across all age groups (table 8A.4.12).

After adjusting for different population age structures, in 2014-15 the current daily smoking rate for Aboriginal and Torres Strait Islander Australians was 2.8 times the rate for non-Indigenous Australians (table 8A.4.7). The gap in smoking rates was widest in remote areas (table 8A.4.8).

 

Figure 8.4.1   Current daily smokers aged 18 years and over, 2001 to 2014-15a, b
a Error bars represent 95 per cent confidence intervals around each estimate. b Rates are age standardised.
Sources: ABS (unpublished) National Health Survey 2001; ABS (unpublished) National Health Survey and National Aboriginal Torres Strait Islander Health Survey 2004-05; ABS (unpublished) National Aboriginal Torres Strait Islander Social Survey 2008; ABS (unpublished) National Health Survey 2007-08; ABS (unpublished) Australian Aboriginal Torres Strait Islander Health Survey 2012-13 (core component); ABS (unpublished) Australian Health Survey 2011–13 (2011-12 core component); ABS (unpublished) National Aboriginal and Torres Strait Islander Social Survey, 2014-15; ABS (unpublished) National Health Survey, 2014-15; table 8A.4.7.

Between 2001 and 2014-15, after adjusting for differences in population age structures, the daily smoking rate declined for both Aboriginal and Torres Strait Islander adults and non‑Indigenous adults, leaving the gap relatively unchanged at around 26 percentage points (figure 8.4.1).

Data for smoking rates reported by State and Territory are available by remoteness in tables 8A.4.2–6 and 8A.4.8−10 and by sex in tables 8A.4.11-12.

Research from the national Talking About The Smokes project also highlighted the importance of taking a comprehensive approach to tobacco control, reporting that a broad range of factors were associated (positively and negatively) with the desire by Aboriginal and Torres Strait Islander smokers to quit (Nicholson et. al 2015).

[1]    The Steering Committee notes its appreciation to the National Health Leadership Forum, which reviewed a draft of this section of the report.

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