Responding to Tobacco and Disadvantage Findings and implications from focus groups among inner Sydney community services Jon O’Brien Senior Program Coordinator Tobacco Control and Social Equity Strategy September 2007

Background to the research Early period of TCSES Developed links with Wayside Chapel Focus groups were a way to: Understand smoker’s perspective Inform possible projects Keep momentum going

Nature of the research Commissioned research company- Urbis Three focus groups - staff and volunteers - service users (under 25) - service users (over 25) Discussion topics - smoking history and behaviour - reasons for smoking - experience of and barriers to quitting - awareness and use of available supports - ideas to help people quit?

Findings: Smoking history and behaviour When? All started in teenage years Youth - social/occasional use, relieve boredom Older clients – with meals, alcohol, coffee, instead of food What? Staff and older clients – a pack a day Clients - mostly tailors and pouch- also bludgeing and butts Ever tried to quit? Almost all staff and older clients Less frequent among youth

Findings: Reasons for smoking Staff Part of every day routine Rapport with clients ‘Constant companion’ Older clients Integral part of their existence Providing relief and comfort in face of adverse circumstances (boredom, anxiety, stress) Youth Socializing, drinking and response to boredom, stress

Findings: Past experiences of quitting Overall Almost all staff/older clients had tried to quit Youth- less concern, urgency- assumed in future >5 yrs Barriers to quitting/factors in resuming smoking Problems with withdrawal (psychological, physical) Adverse conditions; boredom; anxiety; stress - preoccupied with daily challenges so quitting a low priority - already ‘unhealthy’ state means quitting is pointless Social and physical environment (surrounded by smokers) Feeling of inevitability/resignation (older clients)

Findings: Awareness of and use of supports General Relatively good awareness of supports (Quitline, pharmacotherapies, GP, clinics/programs, alternative therapies) Varies opinions as to effectiveness Less active use of supports in older clients Specific No adult clients had used Quitline Consensus about NRT as too expensive/unaffordable

Findings: What else would help? Psychological/emotional support in group or 1 to 1 e.g. to bolster willpower Intensive approach (rehab model) especially for staff/older clients Combine personal support with affordable NRT Address broader social circumstances - “what would we do if we weren’t smoking?” Address smoking and other dependencies in the same service

Implications The need for multifaceted programs that deal with smoking in context- along with other needs and issues E.g. Alternative means to deal with boredom, anxiety, stress Importance of addressing causes of social disadvantage Significance of social and emotional support and and need for strategies to build self-efficacy and sense of control. Value of strengths based approaches? Integration of smoking cessation into AOD services Shaping service environments so more conducive to quitting – e.g. alternative ways to build rapport Access to free/ subsidised NRT

What has happened since the focus groups? Follow-up seminar with local community service agencies to hear findings/consider implications Action ideas: Integration of smoking cessation into existing clinical/preventative health services Develop/access smoking cessation training for community services staff (youth, mental health) Continue awareness raising in service networks

Conclusion Participants has similar reasons for smoking and quitting as other groups. However disadvantage acts to: - intensify reasons to smoke - dilute reasons to quit “Further declines in the prevalence of daily tobacco smoking are unlikely to be achieved unless specific attention and interventions are directed to high prevalence sub groups” Baker et al, 2006. p92.