Tobacco use is responsible for 20% of all deaths in the Aboriginal population.1 Aboriginal Health Workers (AHWs) have a pivotal role in addressing the high smoking prevalence in Aboriginal communities; however, AHWs’ own smoking may be a barrier preventing them from providing quit support and/or information to their communities.2 This letter presents the results of a study that aimed to determine the proportion of Aboriginal health students (AHS) enrolled at an Aboriginal Training College who were current smokers, their smoking attitudes and quitting issues, and their interest in a Quit smoking program. Participation involved completing a written survey. An existing AHW survey developed by Mark et al.3 was modified to be culturally appropriate for students in Western Australia. Survey data was entered into Microsoft Excel and analysed with SPSS version 19. Ethical approval was obtained from the Western Australian Aboriginal Health Information and Ethics Committee to conduct the survey.
The response rate was 69% (52 of 75); 43% (n=22) were current smokers, 16% (n=8) were ex-smokers, and 41% (n=21) were never smokers, with one unknown. The ex-smokers were re-classified into non-smokers (57%) for parts of the analysis (see Table 1). Students from the metropolitan area were significantly less likely to be current smokers (p=0.005). Non-smokers were significantly more likely to have a higher confidence score in addressing smoking (p=0.048) in their community. Almost one-third of students were unsure whether second-hand tobacco smoke caused harm. Approximately 80% reported having smoke-free homes.
|Variable||Current Smoker n=22||Non-smoker n=29||p-value|
|Gender (Males)||13.6% (n=3)||27.6% (n=8)||p=0.312b|
|From metropolitan area||9.5% (n=2)||48.3% (n=14)||p=0.005b|
|Enrolled in nursing course||19.0% (n=4)||35.7% (n=10)||p=0.206b|
|Smoke Free Home||72.7% (n=16)||86.2% (n=25)||p=0.338b|
|Passive smoking harm||63.6% (n=14)||75.9% (n=22)||p=0.371b|
|Mean confidence in addressing smoking||2.67||3.43||p=0.048a|
The majority of smokers had begun smoking at an early age; almost 70% commenced by 15 years of age. Nicotine addiction and stress were important factors in reasons for continuing to smoke, with 80% of current smokers indicating a high or moderate nicotine dependence, and over half the responses including the word ‘stress’ in response to what barriers prevented current smokers from quitting.
Half the current smokers had made an unsuccessful quit attempt, cut down on the number of cigarettes or switched to a lower ‘tar’ content cigarette in the last 12 months in an attempt to quit or modify their smoking habits. Approximately 86% of smokers indicated that they were interested in a college-based quit smoking program.
The smoking prevalence in this AHS population is similar to that in the general Aboriginal population.4 However, the prevalence among metropolitan students was significantly lower than non-metropolitan students. As there is a lower prevalence of smokers in urban areas,4 the cultural norms may have begun to change for urban Aboriginal people who plan to work in health.
Limitations to this survey include the small sample, the response rate and the smoking status being based on self report. In addition, the written survey may not have been appropriate for all students, and some non-responders or partial completers may have found the survey difficult to complete but did not ask for assistance. Confidence in addressing smoking in the community may be explained by other non-examined variables such as whether the student was currently working in health or was a new health student. However, this confidence was not related to the course enrolled or coming from a non-metropolitan area. This finding adds to the evidence base that AHWs’ own smoking is a barrier preventing them from providing quit support and/or information to their communities.2,3.
AHS smokers would like to quit and are interested in a quit support program at the college. Both non-smoking and smoking students would benefit from education on the harms of passive smoking and the importance of smoke-free environments. As the majority of smoking students are from non-metropolitan regions, this highlights the importance of regional programs and partnerships to address smoking. Both nicotine addiction and stress are important factors contributing to AHS ongoing smoking, and these should to be addressed as part of a quit smoking program.
This study contains the first data published, known to the authors, regarding information on smoking prevalence and attitudes of AHS. AHS are an important target group as evidenced by high personal smoking prevalence in this study, and they will play an important future role in addressing smoking within the Aboriginal community. Consequently, they need to be provided with the appropriate personal support and skills to assist them in their role.