Enhancing national data to align with policy objectives: Aboriginal and Torres Strait Islander smoking prevalence at finer geographic levels
Alyson Wright A B D , Ray Lovett A , Yvette Roe C and Alice Richardson AA National Centre for Epidemiology and Population Health, Australian National University, Building 62, Mills Road, Canberra, ACT 2601, Australia. Email: raymond.lovett@anu.edu.au; alice.richardson@anu.edu.au
B Indigenous Health Division, Department of Health, MDP 14, PO Box 9848, Canberra, ACT 2601, Australia.
C Institute for Urban Indigenous Health, 23 Edgar Street, Bowen Hills, Qld 4006, Australia. Email: Yvette.Roe@iuih.org.au
D Corresponding author. Email: alyson.wright@health.gov.au
Australian Health Review 42(3) 348-355 https://doi.org/10.1071/AH16269
Submitted: 29 November 2016 Accepted: 14 March 2017 Published: 5 June 2017
Journal compilation © AHHA 2018 Open Access CC BY-NC-ND
Abstract
Objectives The aim of the study was to assess the utility of national Aboriginal survey data in a regional geospatial analysis of daily smoking prevalence for Aboriginal and Torres Strait Islander Australians and discuss the appropriateness of this analysis for policy and program impact assessment.
Methods Data from the last two Australian Bureau of Statistics (ABS) national surveys of Aboriginal and Torres Strait Islander people, the National Aboriginal and Torres Strait Islander Social Survey 2014–15 (n = 7022 adults) and the National Aboriginal and Torres Strait Islander Health Survey 2012–13 (n = 10 896 adults), were used to map the prevalence of smoking by Indigenous regions.
Results Daily smoking prevalence in 2014–15 at Indigenous regions ranges from 27.1% (95%CI 18.9–35.3) in the Toowoomba region in Queensland to 68.0% (95%CI 58.1–77.9) in the Katherine region in the Northern Territory. The confidence intervals are wide and there is no significant difference in daily smoking prevalence between the two time periods for any region.
Conclusion There are significant limitations with analysing national survey data at finer geographical scales. Given the national program for Indigenous tobacco control is a regional model, evaluation requires finer geographical analysis of smoking prevalence to inform public health progress, policy and program effects. Options to improve the data currently collected include increasing national survey sample sizes, implementing a smoking status question in census surveys, investing in current cohort studies focused on this population or implementing localised surveys.
What is known about the topic? The last geospatial analysis of Aboriginal and Torres Strait Islander smoking prevalence was undertaken in 1997. Current national survey data have not been analysed geospatially.
What does this paper add? This paper provides new insights into the use of national survey data for understanding regional patterns and prevalence levels of smoking in Aboriginal and Torres Strait Islander populations.
What are the implications for practitioners? The findings of the study suggest caution when interpreting prevalence maps and highlight the need for greater sample sizes in national survey data. The analysis is also an opportunity to assess the use of national survey data in evaluating the policy impact of programs targeted at a regional level.
References
[1] Australian Bureau of Statistics (ABS). 4714.0 National Aboriginal and Torres Strait Islander social survey, 2014–15. Canberra: ABS; 2016.[2] Australian Bureau of Statistics (ABS). 4364.0.55.003 Australian health survey: updated results, 2011–2012. Canberra: ABS; 2013.
[3] Australian Bureau of Statistics (ABS). 4364.0.55.001 National health survey: first results, 2014–15. Canberra: ABS; 2015.
[4] Australian Institute of Health and Welfare (AIHW). Australian burden of disease study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: AIHW; 2016.
[5] Ring IT, Dixon T, Lovett RW, Al-Yaman F. Are Indigenous mortality gaps closing: how to tell, and when? Med J Aust 2016; 205 11–13.
| Are Indigenous mortality gaps closing: how to tell, and when?Crossref | GoogleScholarGoogle Scholar |
[6] Vos T, Barker B, Begg S, Stanley L, Lopez AD. Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: the Indigenous health gap. Int J Epidemiol 2009; 38 470–7.
| Burden of disease and injury in Aboriginal and Torres Strait Islander peoples: the Indigenous health gap.Crossref | GoogleScholarGoogle Scholar |
[7] Vos T, Barker B, Stanley L, Lopez A. The burden of disease and injury in Aboriginal and Torres Strait Islander people 2003. Brisbane: University of Queensland; 2007.
[8] Australian Government. Joint media release: $1.6 billion COAG investment in Closing the Gap. 2008. Available at: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-nr-nr164.htm [verified 26 November 2016].
[9] Australian Institute of Health and Welfare (AIHW). National healthcare agreement: PB. 2014 Available from: http://meteor.aihw.gov.au/content/index.phtml/itemId/525831 [verified 26 November 2016].
[10] Australian Government. Joint media release with the Minister for Health and Ageing and the Minister for Indigenous Affairs – Rudd government tackles Indigenous smoking rates and health workforce in next down payments on Closing the Gap. Canberra: Department of Health and Ageing, Department of Indigenous Affairs; 2008. Available at: http://www.formerministers.dss.gov.au/15136/rudd-government-tackles-indigenous-smoking-rates-and-health-workforce-in-next-down-payments-on-closing-the-gap/ [verified 26 November.2016]
[11] Australian Government Department of Health. Department of Health-funded activities. Canberra: Department of Health; 2016. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-funding-lp [verified 26 November 2016].
[12] Australian Government Department of Health. Tackling Indigenous smoking (TIS) – regional tobacco control grants (2015–2018). 2016. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/indigenous-tis-grants [verified 26 November 2016].
[13] Upton P, Davey R, Evans M, Mikhailovich K, Simpson L, Hacklin D. Tackling Indigenous smoking and healthy lifestyles programme review. Canberra: University of Canberra; 2014.
[14] Calma T. Tackling Indigenous smoking. Of Substance 2011; 9 28–9.
[15] Australian Bureau of Statistics (ABS). Australian Aboriginal Torres Strait Islander health survey: updated results, 2012–13. Canberra: ABS; 2013.
[16] Australian Bureau of Statistics (ABS). Tobacco smoking – 4727.0.55.006 – Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. Canberra: Australian Bureau of Statistics; 2013. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4727.0.55.006~2012%E2%80%9313~Main%20Features~Tobacco%20smoking~13 [verified 26 November 2016].
[17] Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Australian Government; 2015.
[18] Stevenson LC, Bohanna I, Robertson JA, Clough AR. Aboriginal people in remote communities in Arnhem Land (Northern Territory) restrict their smoking in some environments: implications for developing and implementing interventions to reduce exposure to environmental tobacco smoke. Drug Alcohol Rev 2013; 32 627–30.
| Aboriginal people in remote communities in Arnhem Land (Northern Territory) restrict their smoking in some environments: implications for developing and implementing interventions to reduce exposure to environmental tobacco smoke.Crossref | GoogleScholarGoogle Scholar |
[19] Thomas DP. Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008. Med J Aust 2012; 197 503–6.
[20] Robertson JA, Conigrave KM, Ivers RG, Hindmarsh E, Clough A. Addressing high rates of smoking in remote Aboriginal communities: new evidence for GPs. Aust Fam Phys 2013; 42 492–6.
[21] Cunningham J. Cigarette smoking among Indigenous Australians. Canberra: Australian Bureau of Statistics; 1997.
[22] Australian Bureau of Statistics. 4727.0.55.002 – Australian Aboriginal and Torres Strait Islander health survey: users’ guide, 2012–13. Canberra: Australian Government; 2013. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4727.0.55.002Appendix102012-13?opendocument&tabname=Notes&prodno=4727.0.55.002&issue=2012-13&num=&view= [verified 26 November 2016].
[23] Australian Bureau of Statistics. 4714.0 – National Aboriginal and Torres Strait Islander Social Survey, 2014–15. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0 [verified 16 November 2016].
[24] Australian Bureau of Statistics (ABS). 4706.0.30.001 – Maps and census profiles, Australian Indigenous geographical classification, 2006. Canberra: ABS; 2008. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4706.0.30.0012006?OpenDocument [verified 27 November 2016].
[25] Australian Bureau of Statistics (ABS). 4720.0 – National Aboriginal and Torres Strait Islander social survey: user guide, 2014–15. Canberra: ABS; 2016. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4720.0~2014-15~Main%20Features~About%20this%20Release~9999 [verified 26 November 2016].
[26] Cumming G. Understanding the new statistics. New York: Routledge; 2014.
[27] Gray D, Saggers S, Drandich M, Wallam D, Plowright P. Evaluating government health and substance abuse programs for indigenous peoples: a comparative review. Aust J Public Health 1995; 19 567–72.
| Evaluating government health and substance abuse programs for indigenous peoples: a comparative review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK283gtlWnsQ%3D%3D&md5=aa336446e6248ae911c26d6b5f7f62b8CAS |
[28] Hunt J. Engagement with Indigenous communities in key sectors. Canberra: Australian Institute of Health and Welfare; 2013.
[29] Thomas D. Smoking prevalence trends in Indigenous Australians, 1994–2004: a typical rather than an exceptional epidemic. Int J Equity Health 2009; 8 37
[30] Thomas DP, Briggs VL, Couzos S, Davey ME, Hunt JM, Panaretto KS, van der Sterren AE, Stevens M, Nicholson AK, Borland R. Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians. Med J Aust 2015; 202 S5–12.
| Research methods of Talking About The Smokes: an International Tobacco Control Policy Evaluation Project study with Aboriginal and Torres Strait Islander Australians.Crossref | GoogleScholarGoogle Scholar |
[31] Thurber K, Banks E, Banwell C. Cohort profile: footprints in time, the Australian Longitundinal Study of Indigenous Children. Int J Epidemiol 2015; 44 789–800.
| Cohort profile: footprints in time, the Australian Longitundinal Study of Indigenous Children.Crossref | GoogleScholarGoogle Scholar |
[32] Australian Institute of Aboriginal and Torres Strait Islander Studies. Mayi Kuwayu Longitundinal Study. 2016. Available at: http://aiatsis.gov.au/research/research-themes/health-and-wellbeing/mayi-kuwayu-longitudinal-study [verified 26 November 2016].
[33] Vidyattama Y, Tanton R, Biddle N. Small areas social indicators for the Indigenous population: synthetic data methodology for creating small area estimates of Indigenous disadvantage. Canberra: University of Canberra; 2013.
[34] Mealing NM, Banks E, Jorm LR, Steel DG, Clements MS, Rogers KD. Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol 2010; 10 26
| Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs.Crossref | GoogleScholarGoogle Scholar |
[35] Rothman KJ, Gallacher JE, Hatch EE. Why representativeness should be avoided. Int J Epidemiol 2013; 42 1012–14.
| Why representativeness should be avoided.Crossref | GoogleScholarGoogle Scholar |
