Reducing smoking in Australia: how to include Aboriginal and Torres Strait Islander people

Australia has succeeded in lowering the overall prevalence of tobacco smoking in the last four decades and has enjoyed a worldwide reputation for innovative policy. However, this success has not extended to Indigenous Australians. Using a narrative review and critique of literature from government, public health, health promotion, marketing and communication on smoking cessation in Australia, we first consider the history of government anti-smoking measures including legislation and communication initiatives including advertising and sponsorship bans, health warnings and 'no smoking' rules affecting anti-smoking norms, culminating in the banning of branding and the advent of tobacco plain packaging. We also review the effects of excise increases and smoking cessation aids such as quit lines and nicotine replacement therapy. For each type of intervention, both population-wide and those specifically directed at Indigenous people, we consider the probable reasons for the failure to reach Aboriginal and Torres Strait Islander people or alter their smoking patterns, and make suggestions for improvements in interventions and their evaluation. We conclude that the history of anti-smoking initiatives in Australia suggests that community-based health initiatives are likely to be more effective in addressing Indigenous people and helping smokers to quit.