Health Promotion Proposal: Tobacco Smoking in Australia

This report presents a comprehensive health promotion proposal targeting tobacco smoking within the Indigenous Australian community, addressing a critical public health concern. It begins with a thorough needs analysis, highlighting the significantly elevated prevalence of tobacco use compared to the national average, and detailing the associated morbidity and mortality, including increased rates of lung cancer and reduced life expectancy. The proposal outlines both short-term and long-term objectives, such as raising awareness, promoting cessation programs, establishing support structures, and influencing cultural behaviors. The strategies include media campaigns, pharmacological interventions, training programs, and community investments, aiming to address the multifaceted nature of tobacco use. An action plan provides a framework for implementation, emphasizing a whole-of-community approach, integrating with existing healthcare systems, and utilizing a multi-component strategy. The report also discusses the importance of securing funding and presents an evaluation plan to measure the initiative's effectiveness in reducing tobacco smoking prevalence and improving overall health outcomes within the Indigenous Australian community.

Running head: HEALTH PROMOTION PROPOSAL
Health Promotion Proposal for Tobacco Smoking among Indigenous Australians
Name
Institution

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Introduction
The indigenous community is an indigenous community found within Australia. Despite
that fact that Australia is regarded as one of the countries in the world with a working tobacco
control, the tobacco smoking prevalence among the indigenous people of the country continues
to be high. The community continues to suffer high mortality and morbidity rates arising from
the abuse of tobacco. Indeed tobacco is to blame for the greatest percentage of preventable
deaths among the indigenous people in Australia. This paper has identified tobacco smoking as a
health concern among the indigenous community of Australia. It therefore presents a health
promotion proposal targeted to curb the epidemic in the community. Explored in the paper is a
needs analysis which provides the rationale and justification for the health promotion initiative.
Subsequent to this, the paper presents the objectives of the health promotion initiative both in the
short term and in the long run. Subsequently, the paper then explores the implementation plan for
the health promotion proposal-herein; both the action plan and the funding or budget for the plan
is discussed. At the end, an evaluation plan is discussed. This presents a strategy to assess the
effectiveness and efficiency of the health promotion plan in reducing the prevalence of tobacco
smoking among the indigenous people of Australia.
Needs Analysis
This section of the paper presents an update on the situation of tobacco use among the
Aboriginal community and the Torres Strait Islander community. It takes a look at the
prevalence of tobacco smoking among the indigenous community by age, gender and indigenous
status. The morbidity and mortality rates arising from tobacco use among the community is also

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discussed. The segment then discusses the current initiatives working on the prevention and
reduction of tobacco smoking in the community and their successes this far. This then provides
the basis for new/more initiatives to add to these efforts.
Prevalence of Tobacco Smoking Among Indigenous Australians
As is the case with most other indigenous community’s world over, the tobacco smoking
rates among Aboriginal and Torres Strait Islanders has been a lot higher than in the rest of the
country. From available literature, tobacco smoking has been a problem for this community for a
long time. In 1994, a study reported that 54% of Aboriginal people (men) were smokers of
tobacco (Magnus et al. 2011). The prevalence among women according to the same study was
46%. In comparison, the average national rates for tobacco smoking was at 20% indicating that
the prevalence of tobacco smoking among indigenous people was more than twice higher. In
2004/5, according to the national survey the prevalence of tobacco smoking had slightly declined
to 52.1% among Aboriginals and Torres Strait Islanders.
More recently according to another study for 2012-2013, the prevalence of tobacco
smoking among young indigenous Australians between ages 15 and 17 was 21.3%. The
prevalence among indigenous young people in the age bracket 18-24 was 48.3%. Comparatively
the national prevalence rates for tobacco using in the said age brackets were 4.1% and 17.3%
respectively (Butler et al. 2010). This indicates that the rate of tobacco smoking among the
indigenous youth was still several times higher than the national average. In the year 2014/15,
the prevalence of smoking among the indigenous males and females had come down to 43.6%.
Most recently in 2017, the prevalence of tobacco smoking among the Aboriginal and Torres
Strait Islander has been estimated at 41.4%.

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Figure 1: Trends in tobacco smoking between 1996 and 2014 (adopted from Thomas & Stevens,
2014)
Despite the fact that this is a decline from the previous years, the figure is still much
higher than the national average for Australia which is just 14%.
Tobacco Smoking Prevalence by Age, Gender and Indigenous Status
According to a national survey conducted in 2014/15, the prevalence of tobacco smoking
among indigenous Australians was higher than the national average in all age groups and in both
gender. The prevalence among the Aboriginal community (39%) is slightly higher than the
Torres Strait Islanders by 4% (Thomas & Stevens 2014). The prevalence among all age groups

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seems to be at the same level among all age groups except for 15-24 and 45-55, which indicate
that men are more affected than their female counterparts.
Figure 2: Variations in tobacco smoking trends by age, gender and indigenous status (Thomas &
Stevens, 2014).
Morbidity and Mortality Attributable to Smoking
The burden of disease that is attributable to tobacco smoking among the indigenous
people of Australia is immense. As an indicator of severity of tobacco smoking, the prevalence
of lung cancer has been found to be higher among the Aboriginal and Torres Strait Islanders
(Martin et al. 2017). Lung cancer is also found to appear among persons of younger ages among
the indigenous communities as compared to non-indigenous Australians. This is attributable to
exposure to tobacco intake at a tender age as already explored in the preceding paragraphs. The
burden of premature deaths in the Aboriginal community is also high.
The Aboriginals and Torres Strait Islanders have a markedly lower life expectancy
compared to the non-indigenous Australians. The 15 year difference is attributable to among
other causes, high tobacco intake. Thomas et al. (2017) submits that if tobacco related deaths
among the indigenous people of Australia were eliminated, the life expectancy would increase

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for both men and women (from 58.5 to 61 for men and from 65.3 to 67 for women). The
prevalence of tobacco related illnesses namely, cervical cancer, pneumonia, cardiovascular
disease and ear infections are higher than the national average. An indigenous Australian is 2 or
3 times more likely to be hospitalized with respiratory diseases related to tobacco smoking as
compared to non-indigenous Australians (Shepherd & Zubrick 2012). This information is
testament to the fact that there is need for more initiatives to deal with the problem
Plan Objectives
The following section identifies the objectives that are to be met by end of the session for the
intervention plan for tobacco control:
 Sustained media campaign to create awareness on dangers of smoking.
 By the end of the intervention process at least 75 % of all adult persons in the Aboriginal
population who are tobacco smokers should be signed up for a cessation plan.
 Pharmacological methods for nicotine replacement.
 A minimum of 50 % of Aboriginal adult smokers should report a 50% reduction in their
smoking rates.
 At least one support center (cessation support center) to be established within every
locality to provide support for person willing to quit.
Strategies for Achieving Objectives
This segment of the paper addresses the strategies that will be employed achieving the
intended objectives of the health promotion proposal. It gives a summary of the strategies that

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will be employed in achieving both the short term as well as long-term objectives of the plan. In
the short term the health promotion initiative targets the following specific objectives:
 Awareness creation-borrowing from Pender (2015), the program intends to produce
salient messages to be disseminated in both mainstream and social media outlets with
information discouraging the use of tobacco among the indigenous people of Australia.
The messages will address the current morbidity and mortality burden attributable to
tobacco smoking and highlight the potential benefits of cessation of tobacco smoking on
health.
 Cessation and Rehabilitation-the program objectifies the provision of opportunities for all
affected persons to access pharmacological alternatives for smoking. This will be
achieved by encouraging them to join cessation programs alongside providing support for
cessation and rehabilitation. As contained in Victorian Health Promotion Foundation
(2014) the program will provide alternatives for tobacco use such as nicotine replacement
therapy, varenicline, nicotine gum, nicotine lozenges, nortriptyline and sustained release
bupropion.
 Support structures-The program idealizes the creation of necessary support structures
within the family, workplace, schools and the general community to create the enabling
environment for persons willing to quit to follow through the cessation process.
 Training-the initiative will also seek to train and equip personnel who will be involved in
the program. This is necessary in order to sensitize workers (including health workers,
community health volunteers, social workers, police and local administrative agents) on
how to offer help to the affected persons and more importantly, how to handle them

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through the cessation process in a manner that support them (Kegler, Rigler & Honeycutt
2011).
In the long term the initiative targets the following broad range objectives:
 Behavior/ culture change
In the long-term, the initiative targets to impact on the behavior pattern of the indigenous
people. The Aboriginal people of Australia have for a long time been known to chew dry leaves
of tobacco even before they had contact with non-indigenous Australians and continue to use dry
leaves of native tobacco even to date. In the history of the aboriginal people, tobacco was used as
a form of currency in the ancient colonial times (Pruss-Ustun et al., 2016). In this region,
Macassan pipes used to smoke tobacco are especially widespread during their traditional
ceremonies. This is testament to the fact that in this community, the use of tobacco is deeply
engrained in the culture. In fact, some of them still believe that chronic diseases such as
respiratory and cardiovascular diseases (which are tobacco related) are caused by sorcery,
conflict between persons or non-observance of taboos. As a consequence a long term objective
must address the cultural belief in the smoking of tobacco and seek to influence the culture to
move away from the tradition.
 Providing access to culturally healthy materials
As already stated the use of tobacco among the Aboriginal and the Torres Strait Islanders
is intricately engrossed and enabled by the culture and history of the communities. In the long
term the initiative targets a behavior and culture shift from these traditions. However, this can

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only be successful if the initiative offers the community some meaningful culturally healthy
options.
 Addressing broader social disadvantages
The program recognizes that any initiative to prevent or reduce tobacco smoking has to
seek redress for underlying factors that contribute to tobacco smoking among the Aboriginal
people. Broader social disparities have been identified as a major causal pathway for tobacco
smoking behavior (World Health Organization 2015). Use of tobacco is associated with low
income, poor housing, low literacy levels and unemployment. The long term objective would be
to seek redress for the said issues in order to deal with enabling factors for smoking
 Long term community investments
The initiative being fully cognizant of the enabling factors for smoking of tobacco among
Aboriginals, further having taken sufficient step towards effecting behavioral change and culture
shift notes that another long term objective would be to invest in the community, in order to
cushion against a reversal of the gains made. As posited by Sokol et al. (2017) this is aimed at
creating opportunities for the community to engage in income generation and shun the negative
behavior of tobacco smoking.
Action Plan
This segment of the report provides an outline for the implementation of the health
promotion proposal and details the resources (both human and material) that would be needed in
the implementation of the project. The need of funding is also discussed in the same section.

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For a health promotion to be effective in curbing the high prevalence of tobacco smoking
among the indigenous community the action plan must take a particular shape and form; firstly
the strategies must adopt whole-of-community approach (Pruss-Ustun et al. 2016). The activities
of the initiative should be integrated within the existing healthcare provision and should bring on
board a variety of sectors in the society. Finally and most importantly the initiative must be multi
component, with each component addressing the various facets of tobacco smoking in the
community. The following are strategies of the action plan;
A cross-sector approach
Actors from any one sector cannot deliver the implementation of the initiative if it is to
succeed. According to Victorian Health Promotion Foundation (2014), if the menace of tobacco
smoking among the Aboriginals and the Torres Strait Islanders is to be recognized as a societal
problem, any approaches to handle it must be multi-sectorial. Owing to this, the implementation
will bring on board persons drawn from different sectors of the society. These will include the
healthcare practitioners (nurses and clinical officers as primary stakeholders). Apart from the
health care practitioners, government agencies such as the National Health Service, non-
governmental organization offering health related services, community health volunteers, social
workers, police and local administration officials will also be involved. This kind of approach
ensures that all skills set required to deal with the problem are brought on board.
Whole-of Community Approach
Successful implementation of a health promotion initiative can only be realized if the
plan is one that includes the whole community. When individuals are signed up to the cessation

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programs the initiatives must put in place mechanisms to ensure that the necessary supportive
structures in which successful cessation can occur are also put in place(Shepherd & Zubrick
2012). This means that persons around the home, workplace, the neighborhood and the
community in general have to be sensitized in order to create capacity in them to help addicts to
recover from tobacco smoking. The strategies must also be integrated within the health care
provision services in the state. This makes it easy to coordinate efforts between the healthcare
providers and the health promotion initiative.
Multi-Component Approach
For a health promotion program to be effective in bringing down the prevalence it ought
to be multi component; i.e. it should have several fronts that aim at finding redress for the
various facets and underlying causal pathways for tobacco use (Pender 2015). High prevalence
of tobacco smoking is directly associated with low income levels, poor housing conditions and
unemployment. Addressing the health component of tobacco use is only the starting point. The
social disadvantages that enable the behavior must be addressed if the prevalence is to be
brought down. This partly explains the need for bringing on board the multi sectorial team
including government agencies so as to help find solutions for the wider societal problems that
enable smoking. As a vital component, the use of tobacco as a stress reliever must also be
tackled, although it all comes down to the sources of stress which takes the plan back to the
identified socio-economic disadvantages.
Funding

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The funding of the health promotion initiative will be drawn from a number of sources.
Just like many other tobacco control programs the initiative will partner with many other like-
minded organizations and entities as already discussed. These include the National Health
Services, non-governmental organization, local administration, social services and the police.
The program will seek funding and logistical support from the partnering entities mentioned.
According to Victorian Health Promotion Foundation (2014) health promotion initiatives cannot
achieve their objectives without support from state and commonwealth governments. Most
importantly the initiative will petition the state government to allocate some substantial amount
of resources towards the same in its fiscal year’s budget.
Evaluation Plan
This section of the plan develops an evaluation plan that would be used to evaluate the
effectiveness of the health promotion initiative. The evaluation plan is commenced by a clear
identification of the purpose of the evaluation. Four main purposes are identified for the
evaluation plan as adopted from Sokol et al. (2017).
i. To assess the impacts of the project activities on the community on the Aboriginals and
the Torres Strait Islander community in terms of meeting the objectives and document the
findings.
ii. To evaluate the extent to which the activities of the initiative have been executed and
their impacts.
iii. To contribute to providing support to higher standards of evaluation planning in the
furtherance of good practice and creation of evidence based practice in community
initiatives for health promotion.

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iv. To create capacity in the Aboriginal and Torres Islander communities to participate in
the implementation of tobacco smoking control initiatives

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Figure 3: Summary of the evaluation questions that the evaluation plan will address (Sokol et
al. (2017)
Process Evaluation
The main aspects of the evaluation plan will study the program documents in determining
the length and breadth to which the program activities have been implemented. As submitted by

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World Health Organization (2015) there will also be data collection by the program persons to
assess the program reach. Reach here is used to refer to the number of tobacco users in the
Aboriginal and Torres Strait Islander community that have been impacted by the program.
Specific aspects of program reach such as program attendance will be weighed as an indicator of
the performance of the initiative.
Data will be sourced from entities such as the project advisory committees, the National
Health Services, program person’s action plans as well as the health services key performance
indictor policy papers. Additionally, if need be, qualitative research methods will be used in the
evaluation. According to Kegler, Rigler & Honeycutt (2011) this will involve methods such as
interviews, questionnaires and open ended surveys to collect the assessment of key stakeholders
on the progress of the initiative.
Figure 4: Major outcomes and indicators of the program reach that will be employed in the
evaluation plan for the Health Promotion Initiative (Sokol et al., 2017)
The second part of the table shows the evaluation plan for the assessment of program reach of
the Health Promotion Initiative

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Conclusion
As presented in the paper, tobacco smoking is an issue of public health concern among
the Aboriginal and Torres Strait Islanders. As evidenced from the prevalence rates of the tobacco
smoking it is a matter that warrants the development of a health promotion initiative. The
proposal plan has presented a need analysis as is evidenced by the high rates of tobacco smoking
in the last several years. The objectives of the health promotion initiative would be to influence a
culture/behavioral change in the attitudes of the indigenous peoples of Australia so they shift
from the use of tobacco. A successful initiative will have to include a multi sectorial, and a
multi-component approach that ensures all pertinent issues linked to tobacco use among the

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indigenous people are addressed. The evaluation plan has clearly documented a pathway for the
monitoring and evaluation of the success of the initiative too.

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References
Butler, R., Chapman, S., Thomas, D. P., & Torzillo, P. (2010). Low daily smoking estimates
derived from sales monitored tobacco use in six remote predominantly Aboriginal
communities. Australian & New Zealand Journal of Public Health, 34, S71–S75.
https://doi.org/10.1111/j.1753-6405.2010.00557.x
Kegler, M. C., Rigler, J., & Honeycutt, S. (2011). The Role of community context in planning
and implementing community-based health promotion projects. Evaluation & Program
Planning, 34(3), 246–253. https://doi.org/10.1016/j.evalprogplan.2011.03.004
Magnus, A., Cadilhac, D., Sheppard, L., Cumming, T., Pearce, D., & Carter, R. (2011).
Economic Benefits of Achieving Realistic Smoking Cessation Targets in Australia.
American Journal of Public Health, 101(2), 321–327.
https://doi.org/10.2105/AJPH.2009.191056
Martin, K., Dono, J., Rigney, N., Rayner, J., Sparrow, A., Miller, C., … Bowden, J. (2017).
Barriers and facilitators for health professionals referring Aboriginal and Torres Strait
Islander tobacco smokers to the Quitline. Australian & New Zealand Journal of Public
Health, 41(6), 631–634. https://doi.org/10.1111/1753-6405.12727
Pender, N. (2015). The Health Promotion Model Manual. Available
http://hdl.handle.net/2027.42/8535043
Pruss-Ustun, A., Wolf, J., Corvalan, C., Bos, R. & Neira, M. (2016).Preventing disease through
healthy environments: A global assessment of the burden of disease from environmental

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risks. Geneva, Switzerland: World Health Organisation 37(6), 1072–1081.
https://doi.org/10.1111/risa.12544
Shepherd, C. C. J., Li, J., & Zubrick, S. R. (2012). Social Gradients in the Health of Indigenous
Australians. American Journal of Public Health, 102(1), 107–117.
https://doi.org/10.2105/AJPH.2011.300354
Sokol, R., Moracco, B., Nelson, S., Rushing, J., Singletary, T., Stanley, K., & Stein, A. (2017).
How local health departments work towards health equity. Evaluation & Program
Planning, 65, 117–123. http s://doi.org/10.1016/j.evalprogplan.2017.08.002
Thomas, D. P., & Stevens, M. (2014). Aboriginal and Torres Strait Islander smoke-free homes,
2002 to 2008. Australian & New Zealand Journal of Public Health, 38(2), 147–153.
https://doi.org/10.1111/1753-6405.12202
Thomas, D. P., Panaretto, K. S., Davey, M., Briggs, V., & Borland, R. (2017). The social
determinants and starting and sustaining quit attempts in a national sample of Aboriginal
and Torres Strait Islander smokers. Australian & New Zealand Journal of Public Health,
41(3), 230–236. https://doi.org/10.1111/1753-6405.12626
Victorian Health Promotion Foundation ‘A‘ŸVicHealth’. (2014). Physical activity, sport and
walking: VicHealth’s Investment Plan (2014-2018). Available:
https://www.vichealth.vic.gov.
au/~/media/resourcecentre/publicationsandresources/physical%20activity/physactivity-
investmentplan-2014-18.pdf?la=en 45

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World Health Organization. (2015). WHO recommendations on health promotion interventions
for maternal and newborn health. Geneva, Switzerland, WHO 37(6), 1096–1107.
https://doi.org/10.1111/risa.12669

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Appendices
Appendix 1: Teaching Plan for Smoking Cessation (adapted from Sokol et al. 2017)

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Appendix 2: Tobacco Cessation Resources (Adapted from Sokol et al. 2017)