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Megan Passey, Rob Sanson-Fisher and Janelle Stirling UK National Smoking Cessation Conference

“Stop Smoking in its Tracks”: An incentives- based smoking cessation program for Australian Aboriginal women provided by antenatal services – a pilot study. Megan Passey, Rob Sanson-Fisher and Janelle Stirling UK National Smoking Cessation Conference London, June 2014. Collaborative project.

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Megan Passey, Rob Sanson-Fisher and Janelle Stirling UK National Smoking Cessation Conference

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  1. “Stop Smoking in its Tracks”:An incentives- based smoking cessation program for Australian Aboriginal women provided by antenatal services – a pilot study Megan Passey, Rob Sanson-Fisher and Janelle Stirling UK National Smoking Cessation Conference London, June 2014

  2. Collaborative project • UCRH, University of Sydney: Megan Passey, Jenny Gale, Janelle Stirling, Cathy Malla • Aboriginal Maternal & Infant Health Strategy (AMIHS) program: Catherine Leatherday, Brenda Holt, Cathy Powell, Sue Rogers, Paula Craig • University of Newcastle: Rob Sanson-Fisher • Community Reference Group: Aunty Bertha Kapeen, Delta Kay, Virginia Paden, Laurel Rogers, Careena Roberts, Janina Roberts, Dana Lavelle, Joyce Roberts, Akarna King, Edith King

  3. Prevalence of smoking • Australian adult population in 2008: • Aboriginal and Torres Strait Islander Australians – 47.0% • Non-Indigenous Australians – 17.5% • Pregnant women in Australia in 2010: • Aboriginal and Torres Strait Islander women – 50.9% • Non-Indigenous women – 14.4% • Among Aboriginal and Torres Strait Islander women: • Highest in outer regional areas, lowest in cities • Declines slightly with age (Scollo and Winstanley 2012) Laws and Sullivan, 2009

  4. Request to help develop quitting program • Few published articles addressing smoking or cessation by pregnant Aboriginal women • Much of the Indigenous research available was done in remote settings • General smoking cessation literature gives little guidance on Indigenous specific issues • Little relevant grey literature; lots of anecdote • Only one properly controlled trial of a smoking cessation intervention with pregnant Indigenous Australian women – not effective (Eadeset al, 2012)

  5. Formative research to help design the quitting program • Qualitative study on North Coast • Interviews with women • Focus groups with women and service providers • Survey of antenatal staff caring for Aboriginal women • Survey of pregnant Aboriginal women

  6. Social drivers of smoking • Smoking ‘normal’ in Aboriginal communities When you don’t smoke you stand out a bit, you feel a bit odd…. Cause everyone around you smokes. Everyone that I know smokes. There is not one person that I know in [town] who doesn’t smoke. So like, it is a bit hard. 24 year old smoker • Cultural issues and smoking • Relationships, obligations and need to belong identified as barrier to quitting • Sharing cigarette and having a yarn contribute to social cohesion and sense of belonging (Passey et al, 2011)

  7. More barriers to quitting • High levels of stress and previous trauma • Partner and other household members smoking • Low self-efficacy for some • Poor knowledge of risk and lack of salience of risk information • Addiction and habit • Pleasure of smoking

  8. Tobacco, cannabis and alcohol Survey with pregnant Aboriginal women in NSW and NT (n=257): • 46% reported smoking tobacco • 15% reported smoking cannabis • 21% reported drinking alcohol • Smokers more likely to also: • Drink alcohol (OR=4.3; 95%CI: 2.12, 9.13) • Smoke cannabis (OR=10.2; 95%CI: 3.73, 34.52)

  9. Assess & support all women Free NRT Resources: Brochures, magnets etc Contingency based rewards Post-partum support Empowerment approach Goals, personal rewards, belief in ability to quit Social support groups Other drugs (alcohol, cannabis referrals) Household members Assist AMIHS team to quit • Build on existing services - AMIHS: • Regular antenatal visits • Good relationships • Ongoing support • Widely accepted in community & homes • Cultural & community knowledge • Reinforcing each others messages

  10. Schedule for visits and rewards • Starts at first antenatal visit • Twice weekly for 3 weeks • Weekly for next 4 weeks • Fortnightly till the birth • Weekly for 6 weeks post-partum • Fortnightly till 6 months postpartum • Value starts at $10, increasing by $2 each visit if confirmed non-smoking

  11. Pilot testing Stop Smoking in its Tracks • 2 AMIHS sites trained and provided with resources and support • Assessed: • Feasibility – provider views, implementation indicators, notes from meetings • Acceptability – to women and providers – interviews, participation rates, notes • Impact – on smoking behaviour, other impacts – record keeping by providers, notes

  12. Participation and completion Participation rate Completion rate

  13. Quit rates – (confirmed by expired CO)

  14. Rewards issued • Amount per woman ranged from $56 to $820 • Median amount issued was $294 • Majority used at electrical appliances stores, then pharmacies

  15. Feasibility • Team capacity • Frequency of visits • Running groups • Distance and transport • NRT expiry dates

  16. Women’s views • Loved the frequency of support, especially when trying to quit or maintain quit status • Rewards very motivating • AMIHS always mentioning smoking helped women realise how important it was • Ongoing support helping women with strategies was valued “it seems like they really care”

  17. AMIHS team views • Good to have something to offer women to help them quit – much more powerful than usual care • Combination of rewards with the other support was really effective • Women who quit were very proud of their success • Thought that most women really valued the rewards and the frequency of the support

  18. Views on Rewards • Considered powerful motivator in one site, but not as powerful with some women in other site • Helped women maintain their motivation and prevent relapse “I think the biggest word is proud. They were just so proud of themselves that they got enough vouchers to get a hair straightener or a – one got a fridge”

  19. Conclusions - the program was: • Acceptable to both women and the providers • Feasible to implement but needs adequate staffing levels and capacity • Impact – high rates of quitting behaviour with confirmed quitting in late pregnancy similar to other programs including incentives • Modifications – consider reducing duration of frequent visits and/or dropping the groups Next phase – larger trial to assess impact in pregnancy & postpartum; adverse effects; feasibility in different settings

  20. Thank you! Acknowledgement of Funding • Studies funded by the Australian Department of Health and Ageing under the Indigenous Tobacco Control Initiative • Currently supported by fellowships from the NHMRC and the NSW Cancer Institute Contact: megan.passey@ucrh.edu.au

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