The Issue of Smoking in Blacktown suburbs

Discuss about the Forming A Smoking Cessation Program For The Indigenous Blacktown Suburb Residents.

The Aboriginal and Torres Strait Islanders comprise of approximately 2.8% of the entire Australian population. Use of tobacco is quite widespread among these people and was prevalent among 39% of the aboriginals, aged more than 15 years in the years 2014-15 (Census, 2018). The health issue that will be discussed in this program is smoking among the indigenous people in Blacktown suburbs of Australia. Blacktown City comprises of the second largest Aboriginal and Torres Strait Islanders, after Central Coast with approximately 9,527 individuals. The Blacktown City Council encompasses a local government area, located in Western Sydney that was found to be comprised of indigenous people who made up to 8% of the entire population, which was quite higher than the Australian and the NSW average (2016 Census QuickStats, 2018).  The indigenous people living in Blacktown suburbs reside in a community, where smoking is considered as a social norm.  This increases their exposure to tobacco use early in their life. Furthermore, the Aboriginal and Torres Strait Islanders living in the Blacktown suburbs belong to the socially disadvantaged population, due to school dropouts, unemployment, and poverty.

One of the most commonly cited reasons for high smoking rates among these indigenous Australians can be attributed to its use as a means of stress alleviation. Smoking has been identified as one of the primary causes for chronic diseases among people, which results in lung cancer.  It has also been recognised as the second largest cause of premature death, among the indigenous community. Inequitable health access to screening programs and treatments make the Aboriginals develop an increase likelihood of getting affected by associated co-morbidities, thereby resulting in death (Gould et al., 2013). Research evidences have also shown that although these indigenous people living in the communities demonstrate a good understanding of the health problems that are associated with smoking, they have less knowledge about the specific harmful effects of tobacco use (Gould et al., 2015). Thus, the primary focus is to formulate a program that will reduce the high rates of smoking among the indigenous people, living in Blacktown suburbs, thereby enhancing their overall health and wellbeing.

Smoking is considered as one of the leading contributors to burden of diseases among the Aboriginal and Torres Strait Islanders.  Tobacco smoking is found to be influenced by a plethora of factors that include normalisation of smoking habits in families and peer groups, positive attitudes towards smoking, and using it as a major coping mechanism. Social determinants of health generally encompass conditions or environment where people are born, learn, live, worship, play, and age. These determinants affect the health functioning and overall quality of life of the people. Such social determinants of health are associated with socio economic position in the community and help in explaining the existing gaps between the average health statuses of the indigenous and non-indigenous people, due to their smoking habits (Kolahdooz et al., 2015). The socio-economic gradient that exists in health status occurs due to high prevalence of risky health behaviours, such as, smoking among the indigenous people living in Blacktown suburbs, due to their low socioeconomic position (Baum et al., 2013). Indigenous Australians have been found to suffer from greater unemployment rate that increases the risk of poor health, through an increased rate of smoking and substance use. An estimated 43% of the indigenous Australians had income in the lower 20% of gross weekly Australian household income. Evidences from population studies indicate that such poor health behaviour affect the exposure to several risk factors like high cholesterol, hypertension, and cardiovascular diseases, all of which are associated with increased rates of smoking (Wang & Hoy, 2013).

Primary healthcare aspects

Research studies also indicate that high proportions of the indigenous people living in the target community who have completed schooling are not daily smokers (72%). Moreover, indigenous people who were unemployed are less likely to stop smoking (40%) (Social Determinants, 2018). Some of the major principles of primary health care interventions include 1) genuine engagement of the local indigenous community for maximizing their participation; 2) formulating a collaborative approach to work with other healthcare providers; 3) focusing on maternal and child health, with the aim of preventing and detecting chronic diseases; 4) secure and adequate resourcing, and 5) service delivery which harmonizes with the ways of life, depicted by the indigenous people (Department of Health, 2018). Thus, it can be deduced that, the issue of high smoking rates in the Blacktown indigenous community needs to be addressed appropriately.

The program that will address this health issue of concern in the Black Town indigenous community will focus on smoking cessation. Smoking cessation refers to the process that helps regular smokers to discontinue the use of tobacco. The active component nicotine present in tobacco makes it difficult for smokers to stop its consumption. A smoking cessation program will be developed for the target population, by taking into account community interventions that will provide support and reinforcement for not smoking. These community interventions will generally focus on formulation and enforcement of appropriate policies, at educational institutions, workplaces and public places, to make them smoke free (Carson et al., 2017). Development of such comprehensive laws will help in increasing the rates of smoking cessation among the indigenous people. Community intervention will also be focused on the design of rules for making smoke-free homes, thereby promoting the cessation.

The program will also build an initiative that focuses on educating the target population regarding the ill effects of active or second hand smoking on the health and overall quality of life (Brown et al., 2016). Psychosocial support that encompasses several aspects of counseling will also form a major part of this program that is estimated to increase effectiveness of the implemented approaches, to prevent the indigenous people living in Blacktown community from smoking (Ochsner et al., 2014). This program will pose direct benefits by greatly reducing the risks of suffering from several chronic health problems, thereby subsequently eliminating the risks of early death among the people.  Health benefits have been found to be greater among individuals who stop smoking at an early age. However, direct benefits can be achieved, regardless of the age of the smoker. This project will address the issue of high rates of smoking by reducing the risk for lung cancer, stroke, peripheral vascular disease, and heart diseases. It will prevent narrowing of the blood vessels and will also reduce symptoms associated with respiratory distress such as, shortness of breath, coughing, and wheezing. Smoking has been found to significantly contribute to infertility among indigenous women. Therefore, the program will also reduce risks of indigenous women to have low birth weight babies.

Developing the program

Planning -The community based intervention will be focused on taking proactive efforts to reach all indigenous smokers living in the Blacktown suburbs, with the help of the existing social institutions. These institutions will include all forms of charities and nonprofit organisations that exist in the region. Community meetings and one-to-one interactions will be held with the key stakeholders to present scientific findings, about how deadly cigarette smoking effects are, and the damage they can create on the target population (American Diabetes Association, 2015). Printable versions of pamphlets will be distributed across all centres to allow the authorities gain a deeper understanding of the proposed program (Spohr et al., 2015). Building on results from previous studies, the planning stage will encompass consulting the healthcare professionals, across major primary health care centres in the area. Previously conducted smoking cessation programs such as, National Tobacco Campaign, Quit for You, Quit for Two, will be reviewed for formulating this situation program. The goals and objectives of the program will be defined to all social institutions and major stakeholders, along with formulating a clear strategy of the measurable outcomes (Twyman et al., 2014). Emphasis will be laid on developing tools that would facilitate empowerment of the indigenous people to quit smoking, through adoption of healthy lifestyle modifications. Trained smoking cessation counselors will be contacted (Chang et al., 2013). Adequate steps will be taken to arrange for funding that would help the socially disadvantaged population to gain maximum benefits from the program.

Implementation- Following development of an effective partnership between the social institutions, healthcare professionals, counselors and local communities, the key community representatives will be charged with the responsibility of representing the project to the Aboriginal and Torres Strait Islanders, living in the suburbs of Blacktown. The intervention will be focused on certain primary channels that are given below:

• Help will be taken by the government for the enforcement of non-smoking policies in public housing, within a year from the effective date of the rule formulation. The policy will prohibit use of all kinds of tobacco products in areas that include administrative office buildings, indivisible living units, common areas, schools, hospitals, and work places, in addition to outdoor places that are located within 30 feet of those areas (Russo et al., 2014). All kinds of tobacco products that involve burning or ignition of tobacco leaves, but not restricted to cigars, pipes, and cigarettes will be included in the rule. Designated smoking areas will be built outside the buffer zone (Snyder, Vick & King, 2015).
• Research evidences have demonstrated the effectiveness of school based smoking cessation programs in increasing knowledge about the negative effects of smoking on the health (Thomas, McLellan & Perera, 2013). Owing to the high school dropout rates among the Aboriginal and Torres Strait Islanders, education will be imparted to all of them at the designated community centres (Yeung, Craven & Ali, 2013). Public education campaigns will be created with the use of adequate funding to reduce use of tobacco (Brown et al., 2014). Researchers have established dose-response relationship between reduced youth smoking and exposure to get the smoking messages (Halpern et al., 2013). Mass media campaigns will that use graphic images and testimonials for portraying negative consequences of smoking, are expected to increase positive beliefs and knowledge, regarding quitting behaviour. Television advertisements that depict ill health consequences have been found particularly effective among the lower socioeconomic smokers. The New York Tobacco Control Programme and Tobacco Free Florida program that combined mass media campaigns along with public awareness, will act as guidelines for implementation.
• Individual counseling sessions held by smoking cessation specialists have been found successful to assist smokers for making successful attempts at quitting smoking. Counselling interventions carried out by psychologists and effective helpers will be focused on the 5 A’s of ask, advice, assess, assist, and arrange (Vallis et al., 2013). Open ended questions will be asked to each participant regarding their first instance of smoking, smoking frequency, ideas of quitting smoking, and perceived health effects, with the aim of initiating conversation. The indigenous people will be advised to stop smoking by using strong personalized language that will help in getting the point across. Effects of second hand smoke to their family and the cost benefits of smoking cessation will be explained. Appropriate assistance and resources will also be provided to the participants who show a willingness to stop their smoking habits. In addition to face to face interviews, telephonic counselling will also be set up at the community centres, to counsel them for smoking cessation.

Evaluation- Follow up visits and telephonic interviews will be scheduled for reviewing the progress of a indigenous person, towards quitting tobacco use. Surveys will also be created to evaluate the housing units and public spaces that have adequately followed the no smoking laws. Rates of hospital admissions due to smoking related co-morbidities will also be measured, once at the beginning and at the end of the intervention. Simple questions will be distributed to the policy makers and commissioners for investigating the effective implementation of cessation policies and guidelines (Ybarra et al., 2014). A longitudinal design will also be created to assess the relationship between utilisation of the cessation resources by the former and current indigenous tobacco users. Telephonic conversations will also help in determining changes in tobacco use behaviour among the Aboriginals and Torres Strait Islanders. The aforementioned steps will help to assess effectiveness of smoking cessation interventions in the Blacktown suburbs.

Discussion of the program

References

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