1. 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

2. 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

3. 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?

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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, p92.