Abstract
BackgroundAboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. However, a high proportion of AHWs are smokers and this undermines their delivery of smoking cessation programs. Smoking tobacco is the leading contributor to the burden of disease in Aboriginal Australians and must be prevented. Little is known about how to enable AHWs to quit smoking. An understanding of the factors that perpetuate smoking in AHWs is needed to inform the development of culturally relevant programs that enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and also optimise the delivery of smoking cessation support to Aboriginal clients.MethodsWe conducted a fundamental qualitative description study that was nested within a larger mixed method participatory research project. The individual and contextual factors that directly or indirectly promote (i.e. perpetuate) smoking behaviours in AHWs were explored in 34 interviews and 3 focus groups. AHWs, other health service staff and tobacco control personnel shared their perspectives. Data analysis was performed using a qualitative content analysis approach with collective member checking by AHW representatives.ResultsAHWs were highly stressed, burdened by their responsibilities, felt powerless and undervalued, and used smoking to cope with and support a sense of social connectedness in their lives. Factors directly and indirectly associated with smoking were reported at six levels of behavioural influence: personal factors (e.g. stress, nicotine addiction), family (e.g. breakdown of family dynamics, grief and loss), interpersonal processes (e.g. socialisation and connection, domestic disputes), the health service (e.g. job insecurity and financial insecurity, demanding work), the community (e.g. racism, social disadvantage) and policy (e.g. short term and insecure funding).ConclusionsAn extensive array of factors perpetuated smoking in AHWs. The multitude of personal, social and environmental stressors faced by AHWs and the accepted use of communal smoking to facilitate socialisation and connection were primary drivers of smoking in AHWs in addition to nicotine dependence. Culturally sensitive multidimensional smoking cessation programs that address these factors and can be tailored to local needs are indicated.
Highlights
Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people
A small number of AHWs identified that they smoked as a means to cope with having Poor Health
As an AHW smoker described: It helps me deal with the pain stuff because the pain makes me feel more agro and niggly towards myself and I get a bit weird and just snapping at other people and in my head I have convinced myself that a cigarette will stop me from doing that and calm me down
Summary
Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. Little is known about how to enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and optimise the delivery of smoking cessation support to Aboriginal clients. In traditional (pre-colonial) society it was common practice for Aboriginal people to chew wild plants containing nicotine, known as pituri. Social control mechanisms limiting consumption of nicotine were employed, by constraining the production and distribution of nicotine-bearing plants. These mechanisms were lost with the advent of colonisation whereupon widespread and frequent exposure to introduced tobacco occurred through rations and wage payments. Aboriginal people rapidly became addicted to the physiological effects of tobacco, and this addiction was exploited by colonists who desired cheap labour and local knowledge [2]
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