Researchers say a new app has the potential to more accurately reflect the nation’s drinking habits.
The ADAC and app researchers hoped the app would be available to download by the end of the year.
Key points :
App developers say it will get a more accurate drinking history than a face-to-face interview with a trained health professional
The Aboriginal Drug and Alcohol Council says the app could replace the National Drug Strategy Household Survey
Researchers say alcohol consumption among Aboriginal women is under-represented by up to 700 per cent in national surveys
The Grog App was designed for use by Indigenous Australians but could be used by anyone.
Dr Kylie Lee, a senior research fellow at the Centre of Research Excellence in Indigenous Health and Alcohol who was also involved in the app’s development, said the new technology would create a more accurate database.
“Aboriginal women, their drinking is under-represented in the national surveys by up to 700 per cent and 200 per cent in men.
“Undeniably we need to do better … this app offers a great opportunity to do that.”
Participants answer a range of broad and specific questions on the app about alcohol and based on that information, they are allocated into a category on a sliding scale from ‘non-drinker’ to ‘high risk’.
Dr Lee said immediate feedback was very helpful.
She said the app could alleviate issues in the way alcohol data was typically collected, for example participants were more likely to be asked about standard drinks but not non-standard containers.
“Like a soft drink bottle, a juice bottle, a sports bottle et cetera so the app has facilities to show how much you put in the bottle,” Dr Lee said.
“It’s very exciting the level of detail you’re going to get.”
Professor Kate Conigrave, the app’s chief investigator and an addiction specialist at Royal Prince Alfred Hospital, agreed the new technology could provide greater clarity.
“I’m aware of the traps,” she said.
“One patient I saw had been recorded by a doctor as drinking three standard drinks a day but when I took a drinking history I said, ‘what do you drink them out of?’, and he showed me a sports bottle,” Professor Conigrave said.
“He was drinking three full sports bottles of wine a day, so that’s about 30 standard drinks a day.”
Professor Conigrave said the national health survey often contained “tiny” numbers from Indigenous communities.
“The sample sizes are so small, it’s hard to get a meaningful picture,” she said.
She said the app would provide a level of comfortability and anonymity which may lead to more accurate data, than an interview with a trained health professional.
“People can be a bit embarrassed about what they’re drinking and it can be a bit hard to admit to someone you know, ‘when I drink I have 12 cans of beer,'” she said.
Taking it to the communities
The app is in its second phase of testing.
In the first phase, Aboriginal and Torres Strait Islanders in remote, regional and urban parts of South Australia and Queensland were asked to describe their drinking habits.
Research on the app has now progressed to the second round, during which the focus was on the technology’s validity as an on-the-ground survey tool.
Scott Wilson, who was leading the development of the app at the Aboriginal Drug and Alcohol Council (ADAC), said the second phase was a “major prevalence study” which would include participants from the local hospital and prison.
The location for the trial has not been made public.
“In the big major surveys people in those areas are always excluded,” Mr Wilson said.
“When you consider that I might be in hospital for an alcohol-related illness or I might be in jail because of an alcohol or drug-related crime, my voice or results are never included.”
The ADAC and app researchers hoped the app would be available to download by the end of the year.
In the meantime, they planned to have discussions with the government over the future use of the app and pursue grant opportunities.
Dr Lee said she was excited for the potential of the new technology.
“Eventually I think it would be a great tool to roll out nationally … using it in the same way as the National Drug Strategy Household Survey,” she said
In 2017–18, Indigenous primary health services were delivered from 383 sites (Table 3). Most sites provided clinical services such as the diagnosis and treatment of chronic illnesses (88%), mental health and counselling services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).
Most organisations provided access to a doctor (86%) and just over half (54%) delivered a wide range of services, including all of the following during usual opening hours: the diagnosis and treatment of illness and disease; antenatal care; maternal and child health care; social and emotional wellbeing/counselling services; substance use programs; and on‑site or off-site access to specialist, allied health and dental care services.
Most organisations (95%) also provided group activities as part of their health promotion and prevention work. For example, in 2017–18, these organisations provided around:
8,400 physical activity/healthy weight sessions
3,700 living skills sessions
4,600 chronic disease client support sessions
4,100 tobacco-use treatment and prevention sessions.
In addition to the services they provide, organisations were asked to report on service gaps and challenges they faced and could list up to 5 of each from predefined lists. In 2017–18, around two-thirds of organisations (68%) reported mental health/social and emotional health and wellbeing services as a gap faced by the community they served.
This was followed by youth services (54%). Over two-thirds of organisations (71%) reported the recruitment, training and support of Aboriginal and Torres Strait Islander staff as a challenge in delivering quality health services.
This is the tenth national report on organisations funded by the Australian Government to provide health services to Aboriginal and Torres Strait Islander people.
Indigenous primary health services
Primary health services play a critical role in helping to improve health outcomes for Aboriginal and Torres Strait Islander people. Indigenous Australians may access mainstream or Indigenous primary health services funded by the Australian and state and territory governments.
Information on organisations funded by the Australian Government under its Indigenous Australians’ health programme (IAHP) is available through two data collections: the Online Services Report (OSR) and the national Key Performance Indicators (nKPIs). Most of the organisations funded under the IAHP contribute to both collections (Table 1).
The OSR collects information on the services organisations provide, client numbers, client contacts, episodes of care and staffing levels. Contextual information about each organisation is also collected. The nKPIs collect information on a set of process of care and health outcome indicators for Indigenous Australians.
This tenth national OSR report presents information on organisations funded by the Australian Government to provide primary health services to Aboriginal and Torres Strait Islander people. It includes a profile of these organisations and information on the services they provide, client numbers, client contacts, episodes of care and staffing levels. Interactive data visualisations using OSR data for 5 reporting periods, from 2013–14 to 2017–18, are presented for the first time.
A wide range of primary health services are provided to Aboriginal and Torres Strait Islander people. In 2017–18:
198 organisations provided primary health services to around 483,000 clients, most of whom were Aboriginal and Torres Strait Islander (81%).
These organisations provided around 3.6 million episodes of care, with nearly 3.1 million (85%) delivered by Aboriginal Community Controlled Health Services (ACCHSs).
More than two-thirds of organisations (71%) were ACCHSs. The rest included government-run organisations and other non-government-run organisations.
Nearly half of organisations (45%) provided services in Remoteand Very remote
Services were delivered from 383 sites across Australia. Most sites provided the diagnosis and treatment of chronic illnesses (88%), social and emotional wellbeing services (88%), maternal and child health care (86%), and antenatal care (78%). Around two-thirds provided tobacco programs (69%) and substance-use and drug and alcohol programs (66%).
Organisations made on average nearly 13 contacts per client
In 2017–18, organisations providing Indigenous primary health services made around 6.1 million client contacts, an average of nearly 13 contacts per client (Table 2). Over half of all client contacts (58%) were made by nurses and midwives (1.8 million contacts) and doctors (1.7 million contacts). Contacts by nurses and midwives represented half (49%) of all client contacts in Very remote areas compared with 29% overall.
At 30 June 2018, organisations providing Indigenous primary health services employed nearly 8,000 FTE staff and over half of these (54%) were Aboriginal or Torres Strait Islander. These organisations were assisted by around 270 visiting staff not paid for by the organisations themselves, making a total workforce of around 8,200 FTE staff.
Nurses and midwives were the most common type of health worker (14% of employed staff), followed by Aboriginal and Torres Strait Islander health workers and practitioners (13%) and doctors (7%). Nurses and midwives represented a higher proportion of employed staff in Very remote areas (22%).
Social and emotional health and wellbeing services are the most commonly reported service gap
Organisations can report up to 5 service gaps faced by the community they serve from a predefined list of gaps. Since this question was introduced in 2012–13, the most commonly reported gap has been for mental health and social and emotional health and wellbeing services. In 2017–18, this was reported as a gap by 68% of organisations.
“Yarn for Life aims to reduce feelings of shame and fear associated with cancer and highlights the importance of normalising conversation around cancer and encouraging early detection of the disease.
It also emphasises the value of support along the patient journey.”
Professor Jacinta Elston, Pro Vice-Chancellor (Indigenous), Monash University, said that finding cancer early gave people the best chance of surviving and living well.
“Yarn for Life seeks to empower Aboriginal and Torres Strait Islander people to participate in screening programs, discuss cancer with their doctor or health care worker openly, and if cancer is diagnosed, complete their cancer treatment.”
Australia’s first Australian Aboriginal surgeon Associate Professor Kelvin Kong, University of Newcastle : continued below
In a national first, Cancer Australia has launched Yarn for Life, a new initiative to reduce the impact of cancer within Aboriginal and Torres Strait Islander communities by encouraging and normalising discussion about the disease.
Cancer is a growing health problem and the second leading cause of death among Indigenous Australians who are, on average, 40 percent more likely to die from cancer than non-indigenous Australians.
The multi-faceted health promotion Yarn for Life has been developed by and with Indigenous Australians, and weaves the central message that it is okay to talk about cancer by sharing personal stories of courage and survivorship from Aboriginal and Torres Strait Islander people.
Yarn for Life features 3 individual experiences of cancer which are also stories of hope.
“While significant gains have been made with regard to cancer overall, Aboriginal and Torres Strait Islander people continue to experience disparities in cancer incidence and outcomes. Cancer affects not only those diagnosed with the disease but also their families, carers, Elders and community,” said Dr Helen Zorbas, CEO, Cancer Australia.
Associate Professor Kong said it was also important for health services to support better outcomes for Indigenous patients by being culturally aware.
“For Aboriginal and Torres Strait Islander people, health and connection to land, culture community and identity are intrinsically linked. Optimal care that is respectful of, and responsive to, the cultural preferences, sensitivities, needs and values of patients, is critical to good health care outcomes.”
The Yarn for Life initiative is supported by two consumer resources which outline what patients should expect at all points on the cancer pathway.
Finding cancer early gives you the best chance of getting better and living well. The good news is there are things you can do to find cancer early. If there are any changes in your body that could be due to cancer, it’s really important to have them checked out. Speak to your health worker about:
any new or unusual changes in your body
how you are feeling
whether you are in any pain
whether anyone in your family has or had cancer
any other problems that are worrying you.
Free screening programs
It’s also important that you and your family participate in screening programs for breast, bowel and cervical cancers.
You can find out more about these free programs including how old you need to be to participate at cancerscreening.gov.au. Remember most of us will need to go to a check-up or screening at some point in our lives—so there’s no shame in talking to family or friends about it as well as your health care worker.
” This report analyses the impact of more than 200 diseases and injuries in terms of living with illness (non-fatal burden) and premature death (fatal burden).
The study found that: chronic diseases such as cancer, cardiovascular diseases, and musculoskeletal conditions contributed the most burden in Australia in 2015 and 38% of the burden could have been prevented by removing exposure to risk factors such as tobacco use, overweight and obesity, and dietary risks.
The overall health of the Australian population improved substantially between 2003 and 2015 and further gains could be achieved by reducing lifestyle-related risk factors, according to a new report by the Australian Institute of Health and Welfare (AIHW). ‘
‘In 2015, Australians collectively lost 4.8 million years of healthy life due to living with or dying prematurely from disease and injury,’ said AIHW spokesperson Mr Richard Juckes.
‘The disease groups causing the most burden in 2015 were cancer, cardiovascular diseases, musculoskeletal conditions, mental and substance use disorders and injuries.
‘After accounting for the increase in size and ageing of the population, there was an 11% decrease in the rate of burden between 2003 and 2015.’
Most of the improvement in the total burden resulted from reductions in premature deaths from illnesses and injuries such as cardiovascular diseases, cancer and infant and congenital conditions.
‘Thirty eight per cent of the total burden of disease experienced by Australians in 2015 could have been prevented by reducing exposure to the risk factors included in this study,’ Mr Juckes said.
‘The 5 risk factors that caused the most total burden in 2015 were tobacco use (9.3%), overweight & obesity (8.4%), dietary risks (7.3%), high blood pressure (5.8%) and high blood plasma glucose—including diabetes (4.7%).’
For the first time, living with illness or injury caused more total disease burden than premature death. In 2015, the non-fatal share was 50.4% and the fatal share was 49.6% of the burden of disease.
Also released today is an overview of health spending that provides an understanding of the impact of diseases in terms of spending through the health system.
‘Together the burden of disease and spending estimates can be used to understand the impact of diseases on the Australian community. However they can’t necessarily be compared with each other, as there are many reasons why they wouldn’t be expected to align,’ Mr Juckes said.
‘For example, spending on reproductive and maternal health is relatively high but it is not associated with substantial disease burden because the result is healthy mothers and babies more often than not.
‘Similarly, vaccine-preventable diseases cause very little burden in Australia due to national investment in immunisation programs.’
” Minister for Health, Greg Hunt, hosted a Government-led roundtable this week to review investment to date in mental health and suicide prevention, to hear from the sector on current gaps and priorities, to understand what is and is not working, and to advise on the upcoming national forum on youth mental health and suicide prevention.
Minister Hunt and Prime Minister Scott Morrison are committed to working towards zero-suicide for all Australians, including our youth. ”
Those in attendance welcomed the Government’s commitment, with a number noting that suicide prevention needs to be a priority across all age groups, especially those groups with the highest suicide rates.
The conversation covered a range of key issues, challenges and opportunities for reform and action. Particular discussion points included:
Social determinants of mental health: there is a fundamental need to focus on the social determinants of mental health for all Australians, noting and emphasising the range of factors that contribute to distress in young Australians. This is an important factor for all young people and communities, with particular reference to the factors impacting on Aboriginal and Torres Strait Islander children and youth.
The impact of trauma and disadvantage: conversation centred on the impacts of trauma and disadvantage and the importance of supporting, for example, young people in out-of-home care, those living in poverty and individuals who are in the justice system.
Support for children and families: in order to improve the lives of young Australians, there is a need to better support children and families in the early years. This includes support for neurodevelopmental disorders. In the same way headspace has been developed for young people, there was a suggestion that mental health services focused on children and families could show real benefits. There is strong support for a focus on prevention
Support for Schools: a continued need was highlighted around the role of, and support for, schools, including primary schools and early learning centres. Schools are a critical component of a ‘whole of community’ approach in building supportive environments for children and young people. It was suggested that for families who may not seek services but who were in need a way of ‘connecting’ may be through digital tools, to identify and support children and parents in those families.
Impact on youth: young people can be seriously impacted and influenced by the suicide death of other young people who are their friends, peers, family members or celebrities. More timely and sophisticated data and comprehensive local responses are needed to assist in the reduction of risk for further lives being lost following a suicide.
Data: The importance of being able to collect, analyse and provide accurate data was highlighted. This data is significant across mental health services and particularly for suicide prevention, treatment and support services.
Service reform: there is a need for service reform to better respond to people with mental health concerns that are too complex to be managed by a GP at a primary health care level but not so acute as to require specialist tertiary mental health services. While there are some good programs and services to build upon, there is a lack of equity across all regions and access remains a key issue for those requiring psychological and other services. We also need to integrate mental health services with drug and alcohol services.
Workforce development: there is an urgent need to focus on training and supporting the diverse professionals working with those at risk of or with mental health issues – health and allied health staff, drug and alcohol workers, school counsellors, psychologists, peer workers and many others. The role of peer workers was recognised as being a critical one and this must be included in all workforce development strategies and initiatives.
Peer and carer support: many families and peers supporting those who are in suicidal distress and/or living with challenging mental health and drug and alcohol concerns needed immediate and quality support themselves as they are also at risk for mental ill-health. Families and friends are the largest non-clinical workforce providing care and support for Australians and there is an immediate need to provide better supports for them.
Regional and national leadership: while attendees were supportive of regional planning and action, it was suggested that stronger guidance at a national level was needed in order to ensure equity and quality of service responses across the country, with a recognition of the importance of the role of Primary Health Networks. Further work is needed to ensure that the roles and responsibilities of all governments were clarified, together with accountability. The Fifth National Mental Health and Suicide Prevention Plan, and particularly the Suicide Prevention Implementation Plan, are key drivers for clearer accountability and integrated and coordinated responses.
Funding models: there was discussion on how best to fund services across the range of needs, including the current review of Medicare and the role of private health insurance.
A collective agreement and strong commitment was reached that a collaborative approach is vital to achieving improved mental health outcomes for all Australians, including children and youth.
There is significant support for a 2030 Vision for mental health and suicide prevention, to be led by the Commission and to ensure that the systematic changes required to best service the community can be identified, prioritised and achieved. This Vision would be look beyond the current plans and strategies.
Attendees acknowledged the commitment to mental health and quality program responses in recent years, together with the increased funding in the 2019/20 federal budget for expanded youth and adult mental health services in the community, together with initiatives to strengthen the collection of critical data around suicide and mentally healthy workplaces. They also noted the current enquiries being undertaken by the Productivity Commission and the Victorian Royal Commission. However, there needs to be an increased focus on longer term systems reform. The Commission has been tasked with taking a leading role in this and will work closely with the sector to develop a reform pathway.
Participants embraced the importance of hope, recognising not only the significant investment to date but that youth mental health services in Australia have been copied by other nations. There is strong support for improvements in mental health and suicide prevention across all levels of government and community.
As outlined by the Minister for Health, this was an opportunity to review the current status and continue this important discussion. It is one of many conversations that will continue with the sector at organisational, group and individual levels.
The Commission will provide updates in sector engagement and discussions as they occur.
“Smoking kills. Smoking robs people, including young people, of their health.
Governments must do more to help people to stop smoking, or to not take up the deadly habit in the first place.
Strong government actions, including making packaging unappealing, keeping tobacco products out of view, and keeping tobacco prices high, have helped to encourage people to quit, or young people not to start.
The Minister for Indigenous Health, Ken Wyatt, is to be commended for continuing funding of $183.7 million over four years for the Tackling Indigenous Smoking program.
Releasing the AMA/ACOSH National Tobacco Control Scoreboard on World No Tobacco Day, AMA President, Dr Tony Bartone
NACCHO and Croakey followers are invited to join Aboriginal Community Controlled Health Services in New South Wales in a Twitter Festival focused on tobacco control initiatives and successes across Australia.
“Across forty years I’ve come to recognise many factoid-driven myths about smoking that just won’t die. If I asked for a dollar each time I had to refute these statements, I’d have accumulated a small fortune.
Their persistence owes much to their being a vehicle for those who utter them to express unvoiced but clear sub-texts that reflect deeply held beliefs about women, the disadvantaged, mental illness, government health campaigns and the “natural”.
Let’s drive a stake through the heart of ten of the most common myths.”
Simon Chapman Emeritus Professor in Public Health, University of Sydney
Women have never smoked more than men. Occasionally, a survey will show one age band where it’s the other way around, but from the earliest mass uptake of smoking in the first decades of last century, men streaked out way ahead of women.
In 1945 in Australia, 72% of men and 26% of women smoked. By 1976, men had fallen to 43% and women had risen to 33%.
As a result, men’s tobacco-caused death rates have always been much higher than those of women. Women’s lung cancer rates, for example, seem unlikely to reach even half the peak rates that we saw among men in the 1970s.
But what about all the “young girls” you can see smoking, I’m always being told. In 2014, 13% of 17-year-old male high school students and 11% of females smoked. In two younger age bands, girls smoked more (by a single percentage point).
Those who keep on insisting girls smoke more are probably just letting their sexist outrage show about noticing girls’ smoking than their ignorance about the data.
2. Quit campaigns don’t work on low socioeconomic smokers
In Australia, 11% of those in the highest quintile of economic advantage smoke, compared with 27.6% in the lowest quintile. More than double.
So does this mean that our quit campaigns “don’t work” on the least well-off?
Smoking prevalence data reflect two things: the proportion of people who ever smoked, and the proportion who quit.
If we look at the most disadvantaged group, we find that a far higher proportion take up smoking than in their more well-to-do counterparts. Only 39.5% have never smoked compared with 50.4% of the most advantaged – see table 9.2.6).
When it comes to quitting, 46% of the most disadvantaged have quit compared to 66% of the least disadvantaged (see table 9.2.9).
There is a higher percentage of the disadvantaged who smoke mainly because more take it up, not because disadvantaged smokers can’t or won’t quit. With 27.6% of the most disadvantaged smoking today, the good news is that nearly three-quarters don’t. Smoking and disadvantage are hardly inseparable.
3. Scare campaigns ‘don’t work’
Countless studies have asked ex-smokers why they stopped and current smokers about why they are trying to stop. I have never seen such a study when there was not daylight between the first reason cited (worry about health consequences) and the second most nominated reason (usually cost).
For example, this national US study covering 13 years showed “concern for your own current or future health” was nominated by 91.6% of ex-smokers as the main reason they quit, compared with 58.7% naming expense and 55.7% being concerned about the impact of their smoking on others.
If information and warnings about the dire consequences of smoking “don’t work”, then from where do all these ex-smokers ever get these top-of-mind concerns? They don’t pop into their heads by magic. They encounter them via anti-smoking campaigns, pack warnings, news stories about research and personal experiences with dying family and friends. The scare campaigns work.
4. Roll-your-own tobacco is more ‘natural’ than factory made
People who smoke rollies often look you in the eye and tell you that factory made cigarettes are full of chemical additives, while roll-your-own tobacco is “natural” – it’s just tobacco. The reasoning here that we are supposed to understand is that it’s these chemicals that are the problem, while the tobacco, being “natural”, is somehow OK.
This myth was first turned very unceremoniously on its head when New Zealand authorities ordered the tobacco companies to provide them with data on the total weight of additives in factory made cigarettes, roll-your-own and pipe tobacco.
For example, data from 1991 supplied by WD & HO Wills showed that in 879,219kg of cigarettes, there was 1,803kg of additives (0.2%). While in 366,036kg of roll-your-own tobacco, there was 82,456kg of additives (22.5%)!
Roll-your-own tobacco is pickled in flavouring and humectant chemicals, the latter being used to keep the tobacco from drying out when smokers expose the tobacco to the air 20 or more times a day when they remove tobacco to roll up a cigarette.
5. Nearly all people with schizophrenia smoke
It’s true that people with mental health problems are much more likely to smoke than those without diagnosed mental health conditions. A meta-analysis of 42 studies on tobacco smoking by those with schizophrenia found an average 62% smoking prevalence (range 14%-88%). But guess which study in these 42 gets cited and quoted far more than any of the others?
If you said the one reporting 88% smoking prevalence you’d be correct. This small 1986 US study of just 277 outpatients with schizophrenia has today been cited a remarkable 1,135 times. With colleagues, I investigated this flagrant example of citation bias (where startling but atypical results stand out in literature searches and get high citations – “wow! This one’s got a high number, let’s quote that one!”).
By googling “How many schizophrenics smoke”, we showed how this percolates into the community via media reports where figures are rounded up in statements such as, “As many as 90% of schizophrenic patients smoke.”
Endlessly repeating that “90%” of those with schizophrenia smoke does these people a real disservice. We would not tolerate such inaccuracy about any other group.
6. Everyone knows the risks of smoking
Knowledge about the risks of smoking can exist at four levels:
Level 1: having heard that smoking increases health risks.
Level 2: being aware that specific diseases are caused by smoking.
Level 3: accurately appreciating the meaning, severity, and probabilities of developing tobacco related diseases.
Level 4: personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases.
Level 1 knowledge is very high, but as you move up the levels, knowledge and understanding greatly diminish. Very few people, for example, are likely to know that two in three long term smokers will die of a smoking caused disease, nor the average number of years that smokers lose off normal life expectancy.
7. You can reduce the health risks of smoking by just cutting down
It’s true that if you smoke five cigarettes a day rather than 20, your lifetime risk of early death is less (although check the risks for one to four cigarettes a day here).
But trying to “reverse engineer” the risk by just cutting down rather than quitting has been shown in at least four large cohort studies such as this one to confer no harm reduction.
If you want to reduce risk, quitting altogether should be your goal.
8. Air pollution is the real cause of lung cancer
Air pollution is unequivocally a major health risk. By “pollution”, those who make this argument don’t mean natural particulate matter such as pollen and soil dusts, they mean nasty industrial and vehicle pollution.
The most polluted areas of Australia are cities where pollution from industry and motor vehicle emissions are most concentrated. Remote regions of the country are the least polluted, so if we wanted to consider the relative contributions of air pollution and smoking to smoking-caused diseases, an obvious question to ask would be “does the incidence of lung cancer differ between heavily polluted cities and very unpolluted remote areas?”
Yes it does. Lung cancer incidence is highest in Australia in (wait for this …) in the least polluted very remote regions of the country, where smoking prevalence happens also to be highest.
9. Smokers should not try to quit without professional help or drugs
If you ask 100 ex-smokers how they quit, between two-thirds and three-quarters will tell you they quit unaided: on their final successful quit attempt, they did not use nicotine replacement therapy, prescribed drugs, or go to some dedicated smoking cessation clinic or experience the laying on of hands from some alternative medicine therapist. They quit unaided.
So if you ask the question: “What method is used by most successful quitters when they quit?” The answer is cold turkey.
Fine print on this English National Health Service poster states a bald-faced lie by saying that “There are some people who can go cold turkey and stop. But there aren’t many of them.” In the years before nicotine-replacement threapy and other drugs were available, many millions – including heavy smokers – quit smoking without any assistance. That’s a message that the pharmaceutical industry was rather not megaphoned
10. Many smokers live into very old age: so it can’t be that harmful
In just the way that five out of six participants in a round of deadly Russian roulette might proclaim that putting a loaded gun to their head and pulling the trigger caused no harm, those who use this argument are just ignorant of risks and probability.
Many probably buy lottery tickets with the same deep knowing that they have a good chance of winning.
11. Today’s smokers are all hard core, addicted smokers who can’t or won’t give up
This claim is the essence of what is known as the “hardening hypothesis”: the idea that decades of effort to motivate smokers to quit has seen all the low-hanging fruit fall from the tree, leaving only deeply addicted, heavy smokers today.
The key index of addicted smoking is the number of cigarettes smoked per day. This creates a small problem for the hardening hypothesis: in nations and states where smoking has reduced most, the average number of cigarettes smoked daily by continuing smokers has gone down, not up. This is exactly the opposite of what the hardening hypothesis would predict if remaining smokers were mostly hard core.
12. Smoking is pleasurable
Repeated studies have found that around 90% of smokers regret having started, and some 40% make an attempt to quit each year. There’s no other product with even a fraction of such customer disloyalty.
But I’m always amused at some die-hard smokers’ efforts explain that they smoke for pleasure and so efforts to persuade them to stop are essentially just anti-hedonistic tirades. Many studies have documented that the “pleasure” of smoking centres around the relief smokers get when they have not smoked for a while. The next nicotine hit takes away the discomfort and craving they have been experiencing.
This argument is a bit like saying that being beaten up every day is something you want to continue with, because hey, it feels so good when the beating stops for a while.
13. Light and mild cigarettes deliver far less tar and nicotine to the smoker than standard varieties
Several nations have outlawed cigarette descriptors such as “light” and “mild” because of evidence that such products do not deliver lower amounts of tar and nicotine to smokers, and so are deceptive.
The allegedly lower yields from cigarettes labelled this way resulted from a massive consumer fraud.
Cigarette manufacturers obtained these low readings by laboratory smoking machine protocols which took a standardized number of puffs, at a standardized puff velocity. The smoke inhaled by the machine was then collected in glass “lungs” behind the machine and the tar and nicotine weighed to give the readings per cigarette.
But the companies didn’t tell smokers two things. So-called light or mild cigarettes had tiny, near-invisible pin-prick perforations just on the filter (see picture). These holes are not covered by the “lips” or “fingers” of the laboratory smoking machine, allowing extra air to be inhaled and thus diluting the dose of tar and nicotine being collected.
But when smokers use these products, two things happen. Their lips and fingers partially occlude the tiny ventilation holes, thus allowing more smoke to be inhaled. Smokers unconsciously “titrate” their smoking to obtain the dose of nicotine that their brain’s addiction centres demand: they can take more puffs, inhale more deeply, leave shorter butt lengths or smoke more cigarettes.
Today, where use of these descriptors has been stopped, the consumer deception continues with the companies using pack colours to loudly hint to smokers about which varieties are “safer”.
14. Filters on cigarettes remove most of the nasty stuff from cigarettes
We’ve all seen the brown stain in a discarded cigarette butt. But what few have seen is how much of that same muck enters the lungs and how much stays there.
This utterly compelling video demonstration shows how ineffective filters are in removing this deadly sludge. A smoker demonstrates holding the smoke in his mouth and then exhales it through a tissue paper, leaving a tell-tale brown stain. He then inhales a drag deep into his lungs, and exhales it into a tissue. The residue is still there, but in a much reduced amount. So where has the remainder gone? It’s still in the lungs!
15. Governments don’t want smoking to fall because they are addicted to tobacco tax and don’t want to kill a goose that lays golden eggs
This is perhaps the silliest and most fiscally illiterate argument we hear about smoking. If governments really want to maximise smoking and tax receipts, they are doing a shockingly bad job of it. Smoking in Australia has fallen almost continuously since the early 1960s. In five of the 11 years to 2011, the Australian government received less tobacco tax receipts than it did the year before (see Table 13.6.6).
Plainly, as smoking continues to decline, diminishing tax returns will occur, although this will be cushioned by the rising population which will include some smokers.
In the meantime, tobacco tax is a win-win for governments and the community. It reduces smoking like nothing else, and it provides substantial transfer of funds from smokers to government for public expenditure.
Those of us who don’t smoke do not squirrel away what we would have otherwise spent on smoking in a jam jar under the bed. We spend it on other goods and services, benefiting the economy too.
16. Most smokers die from smoking caused diseases late in life, and we’ve all got to die from something
Smoking increases the risk of many different diseases, and collectively these take about ten years off normal life expectancy from those who get them.
Smoking is by far the greatest risk factor for lung cancer. In Australia, the average age of death for people with lung cancer is 71.4 (see Table 4.2), while life expectancy is currently 80.1 for men and 84.3 for women.
This means that, on average, men diagnosed with lung cancer lose 8.7 years and women 12.9 years (mean 10.8 years). Of course, some lose many more (Beatle George Harrison died at just 58, Nat King Cole at 45).
If a 20-a-day smoker starts at 17 and dies at 71, 54 years of smoking would see 394,470 cigarettes smoked. At ten puffs per cigarette, that’s some 3.94 million point-blank lung bastings.
It takes about six minutes to smoke a cigarette. So at 20 a day, smokers smoke for two hours each day. Across 54 years, that’s a cumulative 1,644 days of smoking (4.5 years of continual smoking if you put it all together).
So by losing ten years off life expectancy, each cigarette smoked takes about 2.2 times the time it takes to smoke it off the life expectancy that might otherwise have been enjoyed.
17. Smokers cost the health system far less than the government receives from tobacco tax
In June 2015, a senior staff member of Australian libertarian Senator David Leyonhjelm, Helen Dale tweeted:
In Australia, a now old report looking at 2004/05 data estimated the gross health care costs attributable to smoking “before adjustment for savings due to premature death” were $A1.836 billion. In that financial year, the government received $A7,816.35 billion in customs and excise duty and GST on tobacco.
Someone who thought that the fiscal ledger was all that mattered in good government might conclude from this that smokers easily pay their way and perhaps we should even encourage smoking as a citizen’s patriotic duty.
With smokers being considerate enough to die early, these noble citizens lay down their lives early and thus contribute “savings due to premature death” like failing to draw a state pension or needing aged care services late in life. Philip Morris notoriously gave this advice to the new Czech government in 1999.
Other assessments, though, might well point to the values inherent in such assessments. History’s worst regimes have often seen economically non-productive people as human detritus deserving death. Primo Levi’s unforgettable witnessing of this mentality in Auschwitz comes to mind.
18. Big Tobacco is starting to invade low-income nations, now that smoking is on the wane in the wealthiest nations
Sorry, but US and British manufacturers have been aggressively marketing cigarettes in places such as China since the early years of last century. These collectable posters show many featuring Chinese women.
The large populations, the often lax tobacco-control policies and the higher corruption indexes of many low- and middle-income nations makes many of these nirvanas for Big Tobacco.
There are fewer more nauseating experiences than reading the corporate social responsibility reports of tobacco transnationals and then seeing how they operate in smokers’ paradises such as Indonesia. This documentary says it all.
19. Millions of cigarette butts on the world’s beaches leach lots of toxic chemicals into oceans
Cigarette butts are the most discarded items in all litter. Every year uncounted millions if not billions are washed down gutters in storm water and find their way into rivers, harbours and oceans. Cigarette filters and butts contain toxic residue and experiments have shown that placing laboratory fish in containers for 48 hours with leachate extracted from used cigarette butts, 50% of the fish die. From this, we sometimes hear people exclaim that cigarette butts are not just unsightly, but they “poison the oceans”.
But a confined laboratory container does not remotely mirror real life exposures in oceans or rivers. There are some 1,338,000,000 cubic kilometers of water in the world oceans, so the contribution of cigarette butts to the toxification of all this could only excite a homeopath.
If we want to reduce tobacco litter, we need not wander into such dubious justifications. The best way by far is to keep reducing smoking. Industry attempts at portraying themselves as corporately responsible by running dinky little clean-up campaigns or distributing personal butt disposal canisters avoids their efforts to keep as many smoking as possible.
20. Tobacco companies care deeply about their best customers dying early
Naturally, all businesses would rather their customers lived as long as possible so that the cash registers can keep ringing out long and loud. Tobacco companies wish their products didn’t kill so many, but worship the god nicotine for its iron grip on so many.
Visit any tobacco transnational’s website and you will find lots of earnest and caring talk about the companies’ dedication to doing all they can to reduce the terrible harm caused by their products. All the major companies have now invested heavily in electronic cigarettes, so isn’t this a sign that they taking harm reduction seriously?
It might be if the same companies were showing any sign of taking their feet off the turbo-drive accelerator of opposing effective tobacco control policies. But they are doing nothing of the sort. All continue to aggressively attack and delay any policy like tax hikes, graphic health warnings, plain packaging and advertising bans wherever in the world these are planned for introduction.
For all their unctuous hand-wringing about their mission to reduce harm, they are all utterly determined to keep as many smoking as possible. Big Tobacco’s business plan is not smoking or ecigarettes. It’s smoking and ecigarettes. Smoke when you are able to, vape when you can’t. It’s called dual use and some 70% of vapers are doing just that. The tragedy now playing out in some nations is that too many gormless tobacco control experts are blind to this big picture.
NACCHO and RACGP Podcast
Do you smoke?’ A simple preventive activity for clinicians to engage with every patient.
With over 30 years’ experience in Indigenous health, Professor David Thomas from the Menzies School of Health Research discusses updates to the smoking topic from Chapter 1: Lifestyle, in the third edition
They comprise around one-third of female prisoners in New South Wales, despite making up just 3% of the population. The majority of Aboriginal women in prison (more than 80%) are mothers.
Our research team interviewed 43 Aboriginal mothers in six prisons across NSW about their physical and mental health and well-being. We found they were overwhelmingly unable to access culturally appropriate treatments for their mental health, well-being and substance use issues.
These circumstances compounded the poor health and well-being of Aboriginal mothers, and in some instances triggered or exacerbated mental health problems.”
The mothers we interviewed said intergenerational trauma and the forced removal of their children by government services were the most significant factors affecting their health and well-being.
Mothers recounted their own and their relatives’ experiences of being removed from their families as children, as part of the Stolen Generations, painting a picture of longstanding and ongoing intergenerational trauma.
In prison, many of the Aboriginal mothers experienced significant distress due to the trauma of separation from children combined with the stress of the prison environment. Trauma is associated with high rates of co-occurring mental health disorders.
Many mothers had children in the care of family members, but the long distances between the prison and the family’s home made regular contact extremely difficult.
Phone contact in prison was also difficult if the mothers did not have the money to use the prison phones.
Mothers whose children had been taken by government services were reliant on government caseworkers to facilitate their children’s visits. Many mothers reported that these visits were rare, even though they had been ordered by the court. Mothers worried that their children would not be returned to them.
Some Aboriginal women use substances to cope with past trauma. But this is seen as a law and order issue rather than a health problem or coping method of last resort because they haven’t been able to access services to address intergenerational trauma.
This further increases the risk of contact with the criminal justice system and leads to deterioration of mental health and well-being. But no action is taken to address these underlying causes of discrimination and incarceration.
As a result, more than 80% of Aboriginal mothers in prison in NSW report their offences are drug-related. Aboriginal women are more likely to be charged and imprisoned for minor offences than non-Aboriginal women. Consequently, Aboriginal women often cycle through the prison system on shorter sentences or remand (unsentenced) and experience multiple incarcerations.
This compounds intergenerational trauma and cycles of incarceration. It creates another generation of Aboriginal children forcibly removed from their mothers as well as separating Aboriginal mothers from their families and communities.
Some had sustained injuries caused by family violence. Head injuries produced ongoing symptoms such as head pain, blurred vision, and memory loss, which made it more difficult to access treatment.
The mothers reported a high occurrence of reproductive health problems including endometriosis, ovarian cysts, precancerous changes of the cervix, and cervical cancer. The mothers highlighted the links between reproductive health problems and trauma, injury, and poor social and emotional well-being.
Many of the women reported extensive waiting times to access treatment and support, which exacerbated these problems.
Many women who had been taking medication that had been effective for a mental health problem in the community, for example prescription medication for anxiety, were not able to continue on that medication on admission to prison.
They were forced to withdraw from it and wait, sometimes weeks, to see a prison psychiatrist, presenting a serious and imminent risk to their stability, health and well-being.
What can be done?
The incarceration of Aboriginal mothers is a serious public health issue. The gross over-representation of Aboriginal women in prison reflects the inequity and discrimination they face, and the failure of multiple systems to address their needs and divert them from prison.
We urgently need culturally informed approaches to address the health and well-being of Aboriginal mothers in prison and after release to stop ongoing cycles of incarceration and child removal.
The mothers in our study highlighted the need for culturally appropriate services in the community that promote healing for intergenerational trauma. This includes an Aboriginal women’s healing and drug and alcohol service, long-term housing, trauma-informed counselling, and facilities specifically to support Aboriginal women in regaining access to their children.
Aboriginal mothers know what it means to be healthy and stay healthy, but too often do not have access to culturally safe services to support them in their mothering, to realise their health goals, and to remain out of prison and in the community.
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” Every year, on 31 May, the World Health Organization (WHO) and global partners celebrate World No Tobacco Day (WNTD). The annual campaign is an opportunity to raise awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form.
The focus of World No Tobacco Day 2019 is on “tobacco and lung health.” The campaign will increase awareness on:
the negative impact that tobacco has on people’s lung health, from cancer to chronic respiratory disease,
the fundamental role lungs play for the health and well-being of all people.
The campaign also serves as a call to action, advocating for effective policies to reduce tobacco consumption and engaging stakeholders across multiple sectors in the fight for tobacco control. ”
See full detail of World No Tobacco Day Part 2 Below
Those figures have spurred University of Newcastle associate professor Gillian Gould to study what can be done to help reduce rates of Indigenous women smoking while pregnant.
It’s not only that they may be born with low birth rate, or have risks of premature birth, but it can set them up for things like obesity, diabetes, a higher risk of heart disease, and lots of respiratory illnesses.”
“ It’s imperative that Indigenous women have good access to smoking cessation services as 43 per cent of Indigenous women smoke. Essentially, we’re trying to ensure that Indigenous people have the same health outcomes as non-Indigenous people and we need to start before they’re born.
Nothing like this is currently available and there are many systematic barriers that prevent women from accessing medical or antenatal care, which is a problem as it means women may present later than usual during their pregnancy,” Associate Professor Gould said.
We want to start the conversation about smoking as early as possible and found that many general practitioners and obstetricians lack the confidence or skills to provide this specialised type of knowledge.
Some women also receive mixed messages about the safety of quitting smoking or using nicotine replacement therapy during their pregnancy, so this initiative will bring health providers up to speed with the latest evidence-based treatment methods.”
Health professionals and organisations will receive additional training and resources to help support Indigenous women quit smoking during pregnancy under a new multi-million dollar initiative being funded by the Australian Government Department of Health.
Led by renowned smoking cessation expert, Associate Professor Gillian Gould, the initiative will enable health practitioners who treat a pregnant woman in any medical capacity to complete an online training module and access a range of tailored treatment materials.
With smoking in pregnancy having a major impact on the lifelong health of mother and child, including birth complications and low birth weight, Associate Professor Gould said quitting smoking early in pregnancy would help to close the gap on Indigenous health.
As a general practitioner and researcher with the University of Newcastle and Hunter Medical Research Institute (HMRI)*, Associate Professor Gould said the iSISTAQUIT (Supporting Indigenous Smokers to Assist Quitting) initiative would help to provide a culturally sensitive and consistent approach to delivering better care across the country.
Building on lessons and findings from a separate pilot program, also led by Associate Professor Gould, iSISTAQUIT will feature online training via webinars that are self-paced, along with hard copy material such as a treatment manual and patient booklet.
“Many of the resources were developed during the pilot program and trialled across six states, so we’ve adapted them slightly and made them suitable for online delivery,” Associate Professor Gould said.
“Our pilot study revealed that 41 per cent of participants made quit attempts and the resources resulted in a quit rate of 14 per cent and increased engagement between Indigenous women and services.
“Ideally we want these resources to be available to all health practitioners and will look to disseminate them through our existing networks across Aboriginal services, professional colleges and bodies, primary health networks, obstetricians, hospital departments and other medical services throughout Australia when they become available.”
On April 4, 2019 the Department of Health awarded $3,891,801 to the initiative, from the Tackling Indigenous Smoking program. The national development of iSISTAQUIT will commence in the next few months from a newly-established centre in Coffs Harbour.
* HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.
Part 2 How tobacco endangers the lung health of people worldwide
World No Tobacco Day 2019 will focus on the multiple ways that exposure to tobacco affects the health of people’s lungs worldwide.
Lung cancer. Tobacco smoking is the primary cause for lung cancer, responsible for over two thirds of lung cancer deaths globally. Second-hand smoke exposure at home or in the work place also increases risk of lung cancer. Quitting smoking can reduce the risk of lung cancer: after 10 years of quitting smoking, risk of lung cancer falls to about half that of a smoker.
Chronic respiratory disease. Tobacco smoking is the leading cause of chronic obstructive pulmonary disease (COPD), a condition where the build-up of pus-filled mucus in the lungs results in a painful cough and agonising breathing difficulties. The risk of developing COPD is particularly high among individuals who start smoking at a young age, as tobacco smoke significantly slows lung development. Tobacco also exacerbates asthma, which restricts activity and contributes to disability. Early smoking cessation is the most effective treatment for slowing the progression of COPD and improving asthma symptoms.
Across the life-course. Infants exposed in-utero to tobacco smoke toxins, through maternal smoking or maternal exposure to second-hand smoke, frequently experience reduced lung growth and function. Young children exposed to second-hand smoke are at risk of the onset and exacerbation of asthma, pneumonia and bronchitis, and frequent lower respiratory infections.
Globally, an estimated 165 000 children die before the age of 5 of lower respiratory infections caused by second-hand smoke. Those who live on into adulthood continue to suffer the health consequences of second-hand smoke exposure, as frequent lower respiratory infections in early childhood significantly increase risk of developing COPD in adulthood.
Tuberculosis. Tuberculosis (TB) damages the lungs and reduces lung function, which is further exacerbated by tobacco smoking. About one quarter of the world’s population has latent TB, placing them at risk of developing the active disease. People who smoke are twice as likely to fall ill with TB. Active TB, compounded by the damaging lung health effects of tobacco smoking, substantially increases risk of disability and death from respiratory failure.
Air pollution. Tobacco smoke is a very dangerous form of indoor air pollution: it contains over 7 000 chemicals, 69 of which are known to cause cancer.Though smoke may be invisible and odourless, it can linger in the air for up to five hours, putting those exposed at risk of lung cancer, chronic respiratory diseases, and reduced lung function.
Goals of the World No Tobacco Day 2019 campaign
The most effective measure to improve lung health is to reduce tobacco use and second-hand smoke exposure. But knowledge among large sections of the general public, and particularly among smokers, on the implications for the health of people’s lungs from tobacco smoking and second-hand smoke exposure is low in some countries. Despite strong evidence of the harms of tobacco on lung health, the potential of tobacco control for improving lung health remains underestimated.
The World No Tobacco Day 2019 campaign will raise awareness on the:
risks posed by tobacco smoking and second-hand smoke exposure;
awareness on the particular dangers of tobacco smoking to lung health;
magnitude of death and illness globally from lung diseases caused by tobacco, including chronic respiratory diseases and lung cancer;
emerging evidence on the link between tobacco smoking and tuberculosis deaths;
implications of second-hand exposure for lung health of people across age groups;
importance of lung health to achieving overall health and well-being;
feasible actions and measures that key audiences, including the public and governments, can take to reduce the risks to lung health posed by tobacco.
The cross-cutting theme of tobacco and lung health has implications for other global processes, such as international efforts to control noncommunicable diseases (NCDs), TB and air pollution for promoting health. It serves as an opportunity to engage stakeholders across sectors and empower countries to strengthen the implementation of the proven MPOWER tobacco control measures contained in the WHO Framework Convention for Tobacco Control (WHO FCTC).
Call to action
Lung health is not achieved merely through the absence of disease, and tobacco smoke has major implications for the lung health of smokers and non-smokers globally.
In order to achieve the Sustainable Development Goal (SDG) target of a one-third reduction in NCD premature mortality by 2030, tobacco control must be a priority for governments and communities worldwide. Currently, the world is not on track to meeting this target.
Countries should respond to the tobacco epidemic through full implementation of the WHO FCTC and by adopting the MPOWER measures at the highest level of achievement, which involves developing, implementing, and enforcing the most effective tobacco control policies aimed at reducing the demand for tobacco.
Parents and other members of the community should also take measures to promote their own health, and that of their children, by protecting them from the harms caused by tobacco.
The theme this year is Protected Together: Vaccines Work!, and the campaign will celebrate Vaccine Heroes from around the world – from parents and community members to health workers and innovators – who help ensure we are all protected through the power of vaccines.
We seek all ACCHO assistance in supporting women to get vaccinated against influenza and pertussis during pregnancy.
The influenza and pertussis vaccines are available at no cost to pregnant women through the National Immunisation Program (NIP).
The most important factor associated with uptake of influenza and pertussis vaccination during pregnancy is a healthcare provider recommendation.
The Department of Health is undertaking an online campaign to promote pertussis and influenza commencing March through to May 2019.
Key campaign messages
Antenatal vaccination is recommended to protect both pregnant women and their babies from influenza and pertussis and their complications.
Maternal antibodies against pertussis provide protection to babies until they have received at least two doses of pertussis containing vaccines (at six weeks and four months of age).
Maternal antibodies against influenza provide protection to babies for the first few months of life until they are able to be vaccinated themselves at six months of age.
Babies less than six months of age are at greatest risk of severe disease and death from influenza and pertussis.
Pregnant women are also at increased risk of morbidity and mortality from influenza compared with non-pregnant women. Pregnant women are more than twice as likely to be admitted to hospital as other people with influenza.
Please note that the evidence around the timing of pertussis vaccination in pregnancy has recently been reviewed and the pertussis-containing vaccine is now recommended as a single dose between 20 and 32 weeks in each pregnancy, including pregnancies that are closely spaced to provide maximal protection to each infant.
Please take all opportunities to speak to your pregnant patients and their partners about the importance of getting vaccinated against influenza and pertussis during pregnancy. Ideally, vaccination should be part of routine antenatal care.
To support you in these discussions, I have enclosed a number of resources that you and your patients may find useful.
Aboriginal and Torres Strait Islander people aged 10 to 15 years old should receive any missed routine childhood vaccinations. Catch-up vaccines are free through the NIP. See the NIP Schedule for more information.
All children should receive routine vaccines for children aged 10 to 15 years old. These are HPV (human papillomavirus) and diphtheria, tetanus and whooping cough (pertussis), meningococcal ACWY vaccines given through school immunisation programs.
People aged 15 to 49 years old
Aboriginal and Torres Strait Islander people aged 15 to 19 years old should receive any missed routine childhood vaccinations. Catch-up vaccines are free through the NIP. See the NIP Schedule for more information.
The influenza vaccine is free for all Aboriginal and Torres Strait Islander people aged 6 months and over through the NIP.
Aboriginal and Torres Strait Islander people aged 50 years old or more should receive any missed routine childhood vaccinations. Catch-up vaccines are free through the NIP. See the NIP Schedule for more information.
Pneumococcal vaccines are free for Aboriginal and Torres Strait Islander people aged 50 years old or over.