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Barriers to Giving Up Smoking
Smoking in many Indigenous communities has become an accepted or ‘normal’ behaviour and this means that there are many factors that add to the complexities around quitting. Efforts to address high smoking rates will have limited effectiveness unless interventions take into account the social contexts where this smoking behaviour takes place.
These factors include:
The normalisation of smoking in the community - It is difficult for people to quit when the majority of their friends smoke, when they live with other smokers, and when they may not know anyone who has quit successfully. Because so many people smoke, there is no social pressure to quit.
The Culture of Sharing - It is also difficult to be a non-smoker or to quit because of the importance placed on sharing within Aboriginal culture. People share cigarettes with friends and family and it is difficult to say no in this context.
Cultural relevance of current intervention strategies - Public health interventions such as the delivery of cessation advice by health professionals and the use of nicotine replacement therapy are effective at increasing cessation rates in Australia as a whole. However, little is known about whether such interventions are appropriate and effective for and thus transferable to Aboriginal Australians (Ivers 2003).
Adequate understanding of what interventions work - In the past there has been a lack of research on and evaluation of tobacco interventions for Indigenous Australians. New projects targeting Indigenous people will need to be evaluated so that more is known about what does or doesn’t work. It is hoped that with a recent injection of funds targeting Aboriginal and Torres Strait Islander smoking, we will have a better understanding of what strategies work over the coming years.
Some other reasons why previous strategies haven’t worked are a lack of:
- an adequate workforce with appropriate knowledge, skills, confidence
- access to appropriate services and health infrastructure
- sustained and adequate funding of tobacco intervention strategies
Most Indigenous ex-smokers, like other ex-smokers, quit by themselves for health reasons. Smokers who have not been successful at quitting on their own may be more likely to quit with external support, such as Nicotine Replacement Therapy (NRT) or the use of medications such as Buproprian or Varenicline (Ivers 2011).
Recent research suggests that tobacco control activities should address cultural differences in smoking behaviour and motivations to quit in addition to socioeconomic disadvantage. Interventions that are tailored for communities and/or family based approaches may be more successful than those that focus only on the individual (Johnston and Thomas 2008).
