title: Can we measure daily tobacco consumption in remote indigenous communities? Comparing self-reported tobacco consumption with community-level estimates in an Arnhem Land study.
abstract: OBJECTIVE
  In remote Indigenous Australian communities measuring individual tobacco use can be confounded by cultural expectations, including sharing. We compared self-reported tobacco consumption with community-level estimates in Arnhem Land (Northern Territory).
  
  
  METHODS
  In a cross-sectional survey in three communities (population 2319 Indigenous residents, aged ≥16 years), 400 Indigenous residents were interviewed (206 men, 194 women). Eight community stores provided information about tobacco sold during the survey. To gauge the impact of 255 non-Indigenous residents on tobacco turnover, 10 were interviewed (five men, five women). Breath carbon monoxide levels confirmed self-reported smoking. Self-reported number of cigarettes smoked per day was compared with daily tobacco consumption per user estimated using amounts of tobacco sold during 12 months before the survey (2007-2008). 'Lighter smokers' (<10 cigarettes per day) and 'heavier smokers' (≥10 cigarettes per day) in men and women were compared.
  
  
  RESULTS
  Of 400 Indigenous study participants, 305 (76%) used tobacco; four chewed tobacco. Of 301 Indigenous smokers, 177 (58%) provided self-reported consumption information; a median of 11-11.5 cigarettes per day in men and 5.5-10 cigarettes per day in women. Men were three times (odds ratio=2.9) more likely to be 'heavier smokers'. Store turnover data indicated that Indigenous tobacco users consumed the equivalent of 9.2-13.1 cigarettes per day; very similar to self-reported levels. Sixty per cent (=6/10) of non-Indigenous residents interviewed were smokers, but with little impact on tobacco turnover overall (2-6%).
  
  
  CONCLUSIONS
  Smoking levels reported by Indigenous Australians in this study, when sharing tobacco was considered, closely reflected quantities of tobacco sold in community stores.
authors.affiliation: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Qld 4870, Australia. alan.clough@jcu.edu.au
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
authors.forename: David J
authors.initials: DJ
authors.lastname: MacLaren
authors.forename: Jan A
authors.initials: JA
authors.lastname: Robertson
authors.forename: Rowena G
authors.initials: RG
authors.lastname: Ivers
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Conigrave
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000208:ethnology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000208:ethnology; D044382:Population Groups / Q000208:ethnology* / Q000523:psychology; D012111:Residence Characteristics; D057566:Self Report; D012907:Smoking / Q000208:ethnology* / Q000523:psychology; D055815:Young Adult