Talking About the Smokes

Talking About the Smokes (TATS) is a large national research project to better understand the pathways to smoking and quitting for Aboriginal and Torres Strait Islander people, and to evaluate what works in assisting Aboriginal and Torres Strait Islander people to quit smoking. Aboriginal and Torres Strait Islander people are the Indigenous peoples of Australia. The project is a collaboration between research institutions and Aboriginal Community Controlled Health Services (ACCHSs) and their state and national representative bodies. It is modelled on the ITC Project with adaptation to suit the context of smoking cessation and tobacco control for Aboriginal and Torres Strait Islander peoples in Australia. It is funded by the Australian Government Department of Health.

TATS Website: http://www.menzies.edu.au/page/Research/Projects/Smoking/Talking_About_the_Smokes/

Methods

Talking About the Smokes includes a prospective longitudinal study of Aboriginal and Torres Strait Islander smokers and recent ex-smokers; a cross-sectional survey of non-smokers; two cross-sectional surveys of staff of ACCHSs; and descriptions of the tobacco policies and practices at the ACCHSs.

In addition to the surveys of community members, in each ACCHS at each survey wave, a single Policy Monitoring survey was completed describing key tobacco control policies, and all staff of the ACCHSs were invited to complete an abbreviated version of the main community survey.

A quota sampling design was used based on the communities served by 34 Aboriginal Community Controlled Health Services (ACCHSs) and in the Torres Strait. All member services of the National Aboriginal Community Controlled Health Organisation providing comprehensive primary health care were invited to participate, excluding smaller member organisations that only provided narrower services such as just aged care or drug and alcohol rehabilitation. A cluster in the Torres Strait where 15% of Torres Strait Islanders live, but there is no ACCHS was also included. The 35 sites were selected based on the population distribution of the Aboriginal and Torres Strait Islander population by State/Territory and remoteness. In 30 sites, we aimed to interview 50 smokers (or ex-smokers who had quit ≤ 12 months before) and 25 other non-smokers, with equal numbers of women and men, and those aged 18-34 and ≥35 years. In four large city sites and the Torres Strait, the sample sizes were doubled. The total target baseline sample size was 2000 smokers (and recent ex-smokers) and 1000 other non-smokers.

In each location, negotiations with the ACCHS were used to decide on the most practical and representative method of sampling. In some locations this included sampling of known Aboriginal or Torres Strait Islander households, other strategies included opportunistic sampling at community events, at community organisations, at the ACCHS or attending ACCHS groups or activities, and snowballed invitations to people who others suggested may be interested.

In Wave 2, the follow-up survey, in each location, smokers (and recent ex-smokers) who had completed the Wave 1 survey were recontacted. 849 completed recontact surveys: 49% of the 1,721 eligible smokers (and recent ex-smokers) from the baseline survey. The sample was replenished with 597 smokers who had not completed Wave 1 using the same sampling methods as in Wave 1 in order to increase the Wave 2 sample size of smokers. Non-smokers from Wave 1 were not recontacted, and a survey of a new community sample of non-smokers was also not conducted. All staff at each ACCHS were invited at each wave to complete the short staff survey.

Questionnaire Development

Three surveys were developed for each survey wave: (1) the main survey of smokers and non-smokers in the communities served by the ACCHSs, (2) the staff survey, (3) the policy monitoring survey.

The main community survey was based on core questions from ITC surveys, to enable comparisons. Additional questions were added reflecting specific concerns in this setting. The survey includes sections on smoking behaviour, smoking in their social network, secondhand smoke, quitting, brands and prices, smokeless tobacco, knowledge and attitudes, advertising and promotion (including health warnings), medications and cessation support. The wording of some questions was modified to better reflect Aboriginal and Torres Strait Islander colloquial speech.

Staff surveys used a small selection of questions from the main community survey, supplemented by additional questions about their roles at the ACCHS. The policy monitoring survey included questions about the ACCHS and the community it served, tobacco control activities run by the ACCHS, and tobacco control policies (especially smoking bans) at the ACCHS.

Data Collection Methods

The main community surveys were conducted face-to-face with results recorded on a computer tablet, with data uploaded to a secure server. Staff surveys were self-administered on paper or online. The Policy Monitoring survey was completed with key informants from the ACCHS on paper at each wave.

For more details, please see:

https://www.mja.com.au/system/files/issues/202_10/cou00875.pdf

https://www.mja.com.au/system/files/issues/202_10/tho00874.pdf

TATS Contact Information

David Thomas, Project Leader

Email: david.thomas@menzies.edu.au