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Section 1: Smoking Matters This kit is about Aboriginal and Torres Strait Islander Health Workers putting together programs to get people in our communities off the smokes. One of the first things health workers can do is to work out why our people smoke and how the smokes are killing our communities throughout Australia. By having a better understanding of tobacco smoking, health workers are in a stronger position to help others give up the smokes. In Part 1 of this section, we look at the things that stop health workers from helping and supporting our mob to quit smoking. Part 2 outlines the hard facts about tobacco health problems in Aboriginal and Torres Strait Islander communities. In Part 3 we take a look at the history and culture of tobacco use among our people. What’s in Section 1? Part 1: Facing the challenge ahead How health workers can help the mob Part 2: Yes, smoking matters A hard habit to kick The price our community pays Part 3: History and culture of smoking Before colonisation: Chewing and smoking, only on special days With colonisation: Control by non-Indigenous tobacco After colonisation: Too much smoking Health priorities: Give smoking the top health billing Acknowledgments Part 1: Facing the challenge ahead We all know that giving up the smokes is good for the individual and the community—the effects are felt immediately. But there are some real barriers, or blocks, that health workers need to get over if they want to help our mob quit smoking. For instance: Health workers who are smokers themselves may not feel they can help others quit. The high levels of stress faced by many health workers mean it is hard for them to stop smoking. Smoking is not seen as the top health issue facing Indigenous communities. Smoking is accepted as a commonplace social activity that many people do. It is hard to give up when many people around you smoke. It can take many attempts to stop smoking—an Aboriginal or a Torres Strait Islander smoker makes fewer attempts to quit than the average smoker in Australia. Some health workers don’t have the right skills to deliver quit programs confidently to their smoker clients. Nicotine addiction is linked to cannabis (yandi or gunja) use. Cannabis is used at high rates in Aboriginal and Torres Strait Islander communities. Tobacco was used in the colonisation of Aboriginal and Torres Strait Islander people, giving nicotine dependence a historical link. Many health workers simply lack the time, funding, facilities and health promotion information to help our people. This can put off those health workers who want to develop tobacco control programs for their community. Australian Indigenous Tobacco Control Resource Kit 1 How health workers can help the mob Even given these barriers, Aboriginal and Torres Strait Islander Health Workers are still managing to help our mob reduce the effects of smoking. As health workers, we do this by: lending a non-judgmental ‘ear’ to smokers in our community; handing out quit-smoking videos, flip charts and brochures (where available) to our clients; creating smoke-free areas; working to restrict the marketing and display of tobacco products; conducting education sessions for young people on the harm of smoking; running quit support groups; providing clients with access to nicotine replacement therapies; running quit smoking promotions at community events, such as sports carnivals and music festivals; organising walking groups, nutrition information sessions and other activities that promote good health; asking community members who have quit smoking to become involved in these activities and to act as role models to support and encourage others to quit; and trying to give up smoking ourselves through quit groups, counselling and nicotine replacement therapies. Hot Tip #1: Working together is the only way to stop the smokes… Aboriginal and Torres Strait Islander Health Workers can help, and are helping, our communities to overcome tobacco use. At the same time, organisations— both community and government—can help to knock down barriers that prevent health workers from delivering good solutions for their clients. Working together, health workers and organisations can cut down tobacco use in local Indigenous communities. 2 Talkin’ Up Good Air Part 2: Yes, smoking matters Tobacco smoking contributes to the poor health and early death of many Aboriginal and Torres Strait Islander people—even though smoking itself can be prevented. While the number of people who smoke tobacco in the overall Australian population has been dropping steadily for many years, the number of Aboriginal and Torres Strait Islander smokers has not really changed for more than 10 years. Aboriginal and Torres Strait Islander people are twice as likely as non-Indigenous Australians to smoke cigarettes daily. The life expectancy of an Aboriginal or Torres Strait Islander person is about 20 years less than that of the non-Indigenous population. Diseases related to cigarette smoking—such as coronary heart disease, lung cancer, chronic obstructive lung disease (bronchitis and emphysema), and stroke—are major reasons why Aboriginal and Torres Strait Islander people die early. This is why it’s so important for our mob to cut down on tobacco use. Go to CD–ROM: For more information on how smoking affects your health, see Section 7: Part 1, ‘Fact sheets about the health effects of smoking’ Australian Indigenous Tobacco Control Resource Kit 3 A hard habit to kick Here are some facts about the smoking habits of Aboriginal and Torres Strait Islander people in Australia: Smoking is more common among Indigenous Australians than non-Indigenous Australians—more than double the national rate— with one out of every two Aboriginal and Torres Strait Islander people smoking tobacco every day. Smoking is generally more accepted in Aboriginal and Torres Strait Islander communities. Aboriginal and Torres Strait Islander children start smoking younger than non-Indigenous children. Taking up smoking at a young age makes it harder to quit. Of the Aboriginal and Torres Strait Islander people who don’t smoke tobacco, one out of every three are ex-smokers and two out of every three have never smoked. Aboriginal and Torres Strait Islander people are less likely to believe that they can successfully quit their tobacco smoking. 4 Talkin’ Up Good Air The price our community pays Smoking causes health problems among Aboriginal and Torres Strait Islander communities in Australia. The health statistics on Aboriginal and Torres Strait Islander people are alarming: Aboriginal and Torres Strait Islander people die at a younger age than non-Indigenous Australians. On average, Aboriginal and Torres Strait Islander men live to 56 years of age compared with 77 years for non-Indigenous men. Similarly, on average, Aboriginal and Torres Strait Islander women live to 63 years of age compared with 83 years for non-Indigenous women. Aboriginal and Torres Strait Islander people die from heart disease, stroke and vascular diseases (conditions that affect the heart and blood vessels) at nearly three times the rate of the non-Indigenous population. Two out of every three Aboriginal and Torres Strait Islanders die before the age of 65 years, much of which can be attributed to heart disease, stroke and vascular diseases. By comparison, the rates are one in every ten deaths for the non-Indigenous population. Aboriginal and Torres Strait Islander people are nearly four times more likely to die from respiratory system diseases—such as emphysema and lung cancer—than non-Indigenous Australians. Smoking increases the risk of low birth-weight babies and sudden infant death syndrome, or SIDS. Smoking is the most preventable cause of poor health and early death. Australian Indigenous Tobacco Control Resource Kit 5 Part 3: History and culture of smoking Before colonisation: Chewing and smoking, only on special days For thousands of years, Aboriginal people only chewed the indigenous plants pituri or mubbudge, and native tobacco. The leaves of these plants, which are still in use today, are mixed with ash and then chewed to release the nicotine. The plants were used for ceremonial and recreational purposes, and were shared among the group and traded widely. Aboriginal people, mainly in the north of Australia, only started to smoke native tobacco from the early 1700s. This happened when the Macassans, who were the people from what is now eastern Indonesia, visited the northern coast of Australia. They traded and bartered tobacco and smoking pipes, along with other goods, with Aboriginal people for the right to fish. Aboriginal people handed around these pipes in ceremonies to celebrate the social solidarity of their tribe. Tobacco and smoking pipes were traded into the Torres Strait Islands from New Guinea, as Islanders had strong trading and exchange relationships with people from New Guinea. Native tobaccos and tobacco pipes were not used every day, and were limited by strict controls to ceremonies. Many communities did not smoke tobacco until its introduction by Europeans. To this day, some Aboriginal and Torres Strait Islander people continue to use pituri and native tobacco, and in northern Australia Macassan-style pipes are still in use as tobacco plays a role in ceremonies. (Based on research by M. Brady, J. Long and SmokeCheck, Queensland Health, see Section 7, Part 9: ‘References and further reading’ for full citations.) 6 Talkin’ Up Good Air With colonisation: Control by non-Indigenous tobacco Many Aboriginal and Torres Strait Islander people came into contact with tobacco following white settlement and colonisation of Australia. Introduced tobacco quickly replaced native tobacco among communities— there was more of it and it was ready to use. For 150 years, Europeans— government, missionaries and pastoralists—used their tobacco to control Aboriginal and Torres Strait Islander people. Introduced tobacco was a popular ration used by the colonists to pay, reward and bribe Aboriginal and Torres Strait Islander people. As workers became addicted, their labour was controlled. Tobacco was used to persuade the Indigenous population to attend church and give up their traditional lifestyle. Many people who had never used tobacco were introduced to it, becoming addicted at a very young age. Although cash wages were introduced mostly after World War II, tobacco was still included in rations and used as ‘pay’ until relatively recently. Historically, many Aboriginal and Torres Strait Islander people became addicted to tobacco because they had suffered from high levels of personal and social stress caused by colonisation, namely: the dispossession of Aboriginal and Torres Strait Islander land; the confinement of many people to missions and reserves; and the forced removal of children from their families. For example, children forced on to missions, into domestic service or children’s homes ended up having a higher rate of tobacco use than other Aboriginal and Torres Strait Islander people. Australian Indigenous Tobacco Control Resource Kit 7 After colonisation: Too much smoking Aboriginal and Torres Strait Islander people continue to suffer more from illnesses that are caused or made worse by smoking than the rest of the population. The stresses that existed yesterday are still felt today by many in Indigenous communities. These stresses include social and economic inequality. So, Aboriginal and Torres Strait Islander people are: less likely to finish high school than non-Indigenous Australians; more likely to be unemployed and to have a lower average weekly income compared with non-Indigenous Australians; more likely to live in overcrowded and second rate housing; more likely to live in dusty, rural or remote environments, and have poor access to clean water and good food; and more likely to suffer from poor health and early death compared with non-Indigenous Australians. All of these effects are linked to high tobacco use. For instance: Aboriginal and Torres Strait Islander people who have a low level of education are more likely to smoke. Aboriginal and Torres Strait Islander people who are unemployed are more likely to smoke. Aboriginal and Torres Strait Islander people who live in overcrowded and second-rate housing are at risk of breathing in second-hand smoke. Smoking is ‘normal’: Being part of the mob is what counts Tobacco use is now a normal part of everyday life in Aboriginal and Torres Strait Islander communities, and its role in bringing people together is more important than it is in the overall Australian population. Smoking is used as a way to strengthen family relationships and friendships. Not joining in can make people feel like they are not part of the mob. Aboriginal and Torres Strait Islander people have said that when they are with other smokers, it is hard to stop smoking and stay stopped. 8 Talkin’ Up Good Air Health priorities: Give smoking the top health billing Aboriginal and Torres Strait Islander communities have to deal with so many issues that smoking is often put at the bottom of the list. For instance, other health issues—such as drug and alcohol abuse, heart disease, high blood pressure, diabetes, stress, diet and nutrition, and infectious diseases like tuberculosis and HIV/AIDS—are seen as more important. The effects of smoking, on the other hand, can take many years to show. More urgent issues such as the need for running water, accommodation, electricity, nutritious food and accessible health care are priorities for many communities. A survey in the Kimberley showed that other health risks— including alcohol abuse, too much fatty food and sugar, gambling, lack of access to washing machines and refrigeration, crowded housing, and dust and rubbish—were seen as more important than smoking tobacco. Aboriginal and Torres Strait Islander people need lots of support if they are to reduce the high rates of smoking-related illness and death in their communities. Community-based programs that promote healthy living—like those that help people quit smoking—are an important step in improving the wellbeing of Aboriginal and Torres Strait Islander communities. Hot Tip #2: Making your community’s health a priority… Many health organisations now see smoking as a major health problem and are giving tobacco control programs a higher priority. However, community views of smoking have not changed that much. The gap needs to close between these two views if we are to see a drop in the rate of tobacco use in Aboriginal and Torres Strait Islander communities. Our people need to realise that their health will improve as soon as they stop smoking, and that they will drastically cut down their chances of developing heart disease, cancer, breathing problems and infections. Australian Indigenous Tobacco Control Resource Kit 9 Acknowledgments Information from the following organisations was used to compile this section: Australian Bureau of Statistics Australian Institute of Health and Welfare Centre for Aboriginal Economic Policy Research, Australian National University Cooperative Research Centre for Aboriginal and Tropical Health National Aboriginal Community Controlled Health Organisation Queensland Health Go to CD–ROM: For the complete list of references used in this section, see Section 7: Part 9, ‘References and further reading’ 10 Talkin’ Up Good Air