title: "We made the rule, we have to stick to it": towards effective management of environmental tobacco smoke in remote Australian Aboriginal communities.
abstract: Smoking prevalence in remote Australian Aboriginal communities remains extraordinarily high, with rates reported of up to 82%. Widespread exposure to environmental tobacco smoke (ETS) is exacerbated by overcrowded housing. Implementation of existing smoke-free policies is challenged by the normalization of smoking and a lack of appropriate regulation resources. This paper celebrates a grassroots approach to control of environmental tobacco smoke (ETS) in these settings. We report on selected findings from a tobacco intervention study in Arnhem Land, Northern Territory in 2007-2012. In community-level tobacco use surveys at baseline (n = 400 ≥ 16 years), participants reported concern about the constant exposure of non-smokers to tobacco smoke. Suggestions for action included restricting smoking in private and public spaces. We selected three case studies illustrating management of ETS from observational data during the study's intervention phase. Using a critical realist approach, the context and mechanisms that contributed to specific strategies, or outcomes, were examined in order to develop a hypothesis regarding more effective management of ETS in these environments. Our results suggest that in discrete, disadvantaged communities, enhanced local ownership of smoke-free policies and development of implementation strategies at the grassroots level that acknowledge and incorporate cultural contexts can contribute to more effective management of ETS.
authors.affiliation: Tropical Medicine & Rehabilitation Sciences, School of Public Health, James Cook University, Cairns, Queensland 4870, Australia. jan.robertson@jcu.edu.au.
authors.forename: Jan
authors.initials: J
authors.lastname: Robertson
authors.forename: Boris Shane
authors.initials: BS
authors.lastname: Pointing
authors.forename: Leah
authors.initials: L
authors.lastname: Stevenson
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D003256:Community Participation; D004781:Environmental Exposure; D006798:Housing; D015876:Northern Territory / Q000453:epidemiology; D011640:Public Policy; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence / Q000517:prevention & control; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D014028:Tobacco Smoke Pollution