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Pharmacology

Regional Grant funding does not cover TIS teams to offer nicotine replacement therapy (NRT) or other stop smoking medication (SSM) to people who smoke. This is because TIS teams are funded to carry out population health promotion activities, not individual smoking cessation support. However, it is important that TIS workers have up-to-date knowledge of the individual level cessation supports such as NRT and SSM, as these can inform population health promotion activities (e.g community knowledge building).

A number of studies have examined the extent to which NRT is an effective smoking cessation treatment for Aboriginal and Torres Strait Islander populations. Overall NRT is effective, particularly if free/subsidised, and especially if accompanied by good follow-up support services. Evidence about the effectiveness of other SSM such as Varenicline (Champix) and bupropion (Zyban) in Aboriginal and Torres Strait Islander populations is limited. An article from the Talking about the Smokes (TATS) survey,

found that Aboriginal and Torres Strait Islander people are less likely to use NRT or SSM as part of a quit attempt (37%) than non-Indigenous people who smoke (58.5%). However, just under three quarters of those surveyed believed NRT and SSM did help people who smoke to quit. Cost is probably the main barrier to using pharmacological aids. Nicotine patches – available to Aboriginal and Torres Strait Islander patients at a subsidised cost on an authority script through the Pharmaceutical Benefits Scheme (PBS) – were the most common pharmacological aids used by Aboriginal and Torres Strait Islander people who smoke and recent ex-smokers (24%). Varenicline was the next most commonly used pharmaceutical at 11% and nicotine gum at 10%.

Observational research in remote Northern Territory communities, found that following recommended treatment for using NRT (compliance) can be limited by factors such as:

  • difficulties maintaining NRT supplies in remote areas
  • individuals running out of patches because they share with other family members
  • cost, particularly for forms not on the Pharmaceutical Benefits Scheme (PBS).

However, observation of the successful delivery of NRT in one community by a public health nurse showed how compliance improves when regular support and counselling is provided: NRT was supplied in one week blocks with face-to-face follow-up every week at the client’s home. There is also evidence from the

 that combining NRT with intensive counselling and support is effective even in remote settings.

This suggests that focusing on increasing compliance is likely to improve quit attempts. This can be done through:

  • greater discussion around NRT options (e.g. gum, patches or combined therapy)
  • including patients in the decision process
  • providing appropriate regular support.

Other activities to increase the use of NRT in helping Aboriginal and Torres Strait Islander people who smoke to quit are:

  • providing better information about NRT to the community
  • including access to NRT as part of a broader tobacco control program.

Another program which demonstrates the effectiveness of a comprehensive service for supporting quit attempts is the

 smoking cessation program based in ACT. The program combines weekly support groups, access to NRT (through a GP), phone follow-up, and home and workplace outreach (see Box 1).

Box 1: Violet Sheridan and No More Bundah
Violet Sheridan has been an Aboriginal Health Worker at the Winnunga Nimmityjah Health Centre, an Aboriginal Health Service in the Australian Capital Territory, working within a substance abuse project. She has also smoked for most of her teenage and adult years. Seeing her mother-in-law struggle with the effects of emphysema, and similarly experiencing trouble with her own breathing, she decided to take advantage of the No More Bundah program offered by Winnunga Nimmityjah. No More Bundah is an eight-week quit program run by Winnunga that promotes smoking cessation through the use of counselling and group meetings, together with a free two-week supply of nicotine replacement therapy. Violet felt that the initial support provided by the nicotine patches made the difference this time in giving up smoking. Her body no longer craved the nicotine in cigarettes, which in turn made it easier to change her impulse to reach for a cigarette out of habit. ‘When I felt like I wanted a cigarette I knew it wasn’t my body needing the cigarette it was just my mind. So I’d tell myself to wait a couple of minutes or go and have a glass of water, and the urge would have gone’. It is this change in her behaviour around smoking that Violet feels is the key to her successfully giving up. Even though she is with people who smoke all the time she is able to modify what she does when the urge strikes. Even when she no longer attended the support groups, Violet was able to apply the skills that she had learned to get through those times when temptation—or simple habit—would have otherwise weakened her resolve. Now Violet is feeling the benefits of being smoke free for ten months. Her sense of smell and of taste have returned and her energy level has increased so that she is now able to go for long walks. Her doctor has told her that her heavy cough, a result of thirty-seven years of smoking, will take a little longer to clear but her breathing has improved remarkably. Asked what she would say to anyone considering giving up smoking, Violet said: ‘Have a go and just don’t give up hope. It’s the hardest thing I’ve ever done and it took me twenty attempts, but I did it with the help I got through No More Bundah. All my friends and family are really proud of me’.Material adapted from:

Further reading

  • Choosing evidence-based activities

  • Cold turkey
  • Smoke-free
  • Mass media and social marketing
  • Social media and social networking
  • Pharmacology
  • Brief intervention
  • Counselling
  • Quitline
  • Using physical activity to enhance quit rates

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