Targeting Tobacco An alternative approach

Carolyn Baker

Why another smoking project?

The Targeting Tobacco project aims to contribute to reducing Tasmanian smoking rates to 15% by 2016.

The current adult smoking rate for Tasmanians (daily & occasional) is 21.7% and is declining ..

Daily and occasionally smoking rates as defined in the Australian Health Survey 2011/12.

 BUT

Smoking rates are increasing for some

People in lower socio economic groups have higher smoking rates than people in higher socioeconomic positions

AND

People facing multiple disadvantages have the highest smoking rates of all.

Australian National Preventative Health Agency 2013

People in low socioeconomic groups

People experiencing unemployment

People with a mental illness

People living with psychosis

People experiencing homelessness

People with substance use disorders

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

0.246

0.276

0.324

0.66

0.77

0.85

Tobacco is a social justice issue

1 in 2 smokers will die from smoking

Higher prevalence of smoking by disadvantaged groups means that people• start smoking earlier• smoke for longer• smoke more heavily • fewer attempt to quit

Higher prevalence = higher level of health problems + impact on disposable income

Financial impacts of smoking

In Australia among smoking households

11% suffer severe financial stress

poorest households spend 20% of their income on tobacco

children twice as likely to go hungry

less income for housing/rent

higher absenteeism from work

Sources: Siahpush, Borland & Scollo (2003); Siahpush,Spittal & Singh (2007); Siahpush, Yong, Borland, Reid & Hammond (2009); Scollo & Winstanley (2008)]

Benefits of quitting

Quitting smoking brings immediate financial benefits and reduces suffering from financial stress by 42%.

A pack-a-day smoker can save more than $5000 a year by quitting.  

Tackling Tobacco Program NSW indicates community sector clients (with an average income of $400 or less) spent around $64 per week on smoking.

Quitting smoking potentially enables people on low incomes to increase their disposable income

  Source: Cancer Council NSW (2012)

A vicious cycle

Social disadvantage and deprivation

Creates vulnerability to smoking

Smoking prevalence

Makes circumstances worse

Aim of Targeting Tobacco Project

Reduce smoking-related harm amongst disadvantaged groups by

Building capacity of social and community service organisations to

Make smoking care part of usual care

Support clients to quit

What we have done to date

State-wide survey of Tasmanian community service organisations in April 2014

Investigated how social and community service organisations address smoking with their clients and staff.

To read the final report go to Quit Tasmania website http://www.quittas.org.au/resources-professionals/targeting-tobacco

ResultsFigure 1. Main client groups’ individuals work with

Note: As responders could indicate more than one client group with whom they work, percentage figures do not equal 100%.

Over 76 responses to the survey were received from 44 different community service organisations around the state.

Half the respondents were actively engaged as either case workers 17 (24%) or support workers 19 (26%)

Proportion of smokers working in the community services sector daily and occasional was estimated at 27%

Community workers believed more than half their clients smoked

Smoking Policies

Please indicate what the policy relates to (tick all that apply):

Response %

Response Count

Smoking inside the building and offices 90% 65

Smoking in work vehicles 76% 55

Staff smoking with clients 44% 32

Staff smoking on home/client visits 39% 28

Smoking by clients on accompanied outings 21% 15

Smoking by clients in temporary housing/accommodation 19% 14

Provision of support for staff and /or clients to quit smoking 35% 25

85% of respondents stated their organisations had smoking policies

Most policies covered smoking in buildings (90%) and vehicles (76%),

Fewer policies exist around staff and client smoking on home visits, accompanied outings and in temporary accommodation.

Table 1. Organisation policies

Organisation Practices47% respondents indicated their organisational practices did not include recording a client’s smoking status on their files

32% of community service workers never ask clients if they are interested in quitting or cutting down their smoking

39% never record quit smoking attempts

44% never include quit smoking plans as part of a service to clients

26% never refer clients for additional quit smoking support.

Figure 3. Frequency of recording smoking status of clients

Attitudes to smoking

74% of community service workers believed smoking ads to their clients’ disadvantage.

75% of respondents believed smoking clients should receive support to quit smoking

62% of respondents believe smoking care should be offered to clients by their organisation

40% believed the organisation currently supported staff to be able to provide this assistance

Skills and confidence to address smokingStaff training on smoking cessation had occurred in 24% of organisations in the last 12 months

While community workers were confident in discussing smoking with clients, the confidence levels of staff in knowledge about ways to quit using nicotine replacement therapy and its cost was low.

This reduces the ability of staff to inform clients about current ways they can go about quitting and in turn restricts opportunities for staff to offer a meaningful brief smoking intervention to clients.

How confident are you about asking the following?

Not at all%

Unsure%

Moderately confident

%

Extremely confident

%

Asking someone about their smoking 4 5 29 33

Providing brief advice and support for someone wanting to quit smoking

7 6 35 24

Who to refer clients to when they are interested in quitting smoking

0 7 34 31

Understanding the short and long term health consequences of smoking

0 2 23 47

Understanding and promoting the benefits of quitting

2 6 23 41

Understanding the process of nicotine addiction, quitting and relapse

3 11 28 29

Understanding the impact of second hand smoke

3 5 24 39

Understanding (NRT) and cost 14 19 22 17

“what skills, support and resources are needed to better enable organisations to support clients and staff interested in quitting smoking?”

Training and education

Review community organisation smoking policies

Improve client documentation

Review smoking resources

Literacy issues were identified as a weakness for many people accessing community services.

Easy to read, visual materials would be of use in discussing smoking with clients.

The next 6 months

Quit Tasmania is offering free 1 hour briefings to community service organisations keen to update staff on ways to support staff and clients interested in quitting.

Sessions will be targeted to the population groups with whom organisations predominantly work

Briefings will be held August to December 2014.

A Targeting Tobacco Community Worker Kit of helpful resources is being developed

For more information

Carolyn Baker

Cancer Council and Quit Tasmania

Ph: 62428109

Email: cbaker@cancertas.org.au

Visit: www.quittas.org.au