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DEPARTMENT OF HEALTH AND COMMUNITY SERVICES

DHCS Tobacco

Framework for Action 2006-2009

J A life saving partnership

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DL 362.296 TOB 2007

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NT Dept. of Health

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Acknowledgements The Alcohol and Other Drugs Program are grateful to the many people who have assisted in the production of this report by sharing knowledge and information and by engaging in the consultation process. All those who attended the consultation forum or submitted comments in writing are listed.

Agency Agency NT Police - School Based Police Department of Justice Licensing and Regulation

Australian Government Department of Health and Ageing

Department of Education: Department of Chief Minister:

• Health Promoting Schools; and • Office of Women's Policy; and

• NTWorkSafe • Office of Youth Affairs Department of Health and Community Non Government Organisations: Services: • National Heart Foundation of Australia,

NT Division;

• Alcohol and Other Drugs • Quit Victoria; Program/Services; • Cancer Council NT;

• Maternal, Child and Youth • Asthma Foundation; Health; • Healthy Living NT;

• Preventable Chronic Disease; • Top End Division of General Practice; • Remote Health; • Central Australia Division of General • Mental Health; Practice; • Health Promotion; and • Danila Dilba Aboriginal Health Centre; • Oral Health. • Anyinginyi Congress Aboriginal • Health Gains and planning Corporation;

• Central Australian Aboriginal Congress;

• MIWAT J Health Aboriginal Corporation;

• Australian Hotels Association (NT);

• ASH (Action on Smoking and Health);

• YWCA (Young Women's Country Association);

• St Vincent de Paul Society (NT) Inc; and

• Australia Hotels Association (NT)

© Department of Health and Community Services, Northern Territory 2007

This publication is copyright. The information in this report may be freely copied and distributed for non-profit purposes such as study, research, health service management and public information subject to the inclusion of an acknowledgment of the source. Reproduction for other purposes requires the written permission of the Director of Alcohol and Other Drugs Program of the Department of Health and Community Services, Northern Territory.

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An electronic version is available at: www.smokefree.ntgov.au ~V.LTH~

~~ J..:r General enquiries about this publication and requests for hard copies should be direct to: ~\.

~ < Alcohol and Other Drugs Program, ;# 't,\~ Department of Health and Community Services 1 g J~l'I 'L~'\~ ·. J PO Box 40596, Casuarina, NT 0811 ~-

~ ,.~ Phone: 1800 888 564 ~#~ This Tobacco Framework is in line with the National Tobacco Strategy 2004 - 2009. Copies of the National Tobacco Strategy 2004- 2009 are available at: www.nationaldrugstrategy.gov.au

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l l Table of contents

l Introduction 4

Overview 5

l Aim Outcome Areas Primary Outcomes

l Partnerships Already Established

l Smoking Cessation 6

l Education and Awareness Raising 7

l Research, Evaluation and Monitoring 8

Resource Development 9

) Legislation and Policy 10

I Indigenous Focus 11

I Useful Links 12

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Introduction The aim of this framework is to improve the health of Northern Territorians by reducing the harm caused by chewing and smoking tobacco especially among the priority groups, young Territorians and Indigenous Territorians.

In the Northern Territory, tobacco smoking remains the leading cause of preventable death and disease. Tobacco smoking is the single biggest cause of premature death and disability in Australia and directly results in the premature death of one in five Territorians. Tobacco use has been estimated to cost Australia $21 billion a year in health care, lost productivity, life and other social costs. Every 30 minutes, another Australian dies from tobacco smoking. Smoking, more than any other identifiable factor, contributes to the gap in healthy life expectancy betvJeen those most advantaged and those most in need(1 ). An estimated 50,000 Territorians over the age of 14 continue to smoke daily (2).

Over the past few years, the Northern Territory Government has invested in the development and distribution of resources, incentive grants for Indigenous communities, public awareness campaigns, youth prevention campaigns and the introduction of the Tobacco Control Act 2002 reducing the number of places where people can legally smoke.

This framework aims to compliment the Tobacco Control Act 2002 by further reducing exposure to environmental tobacco smoke, preventing young people from starting and supporting smokers to quit.

While this framework is a guiding document taking into account the statistics from the Health Gains Planning Fact Sheet 2 (December 2006), key partners must also be prepared for emerging issues and evidence in tobacco control locally, nationally and internationally.

This framework has been developed in consultation with key agencies and individuals to guide the direction of tobacco initiatives in the Northern Territory over the next 4 years. The priority areas are protection of youth from tobacco marketing, second hand smoke and access to tobacco, and reducing smoking prevalence among Indigenous Territorians through innovative new programs, resources and support to communities for clean air policies. Ho\Never, the whole of community will experience the benefits.

This framework outlines local action to complement the National Tobacco Strategy 2004-2009 and the provisions of the World Health Organisation Framework Convention on Tobacco Control (ratified by the Australian Government). Both of these documents provide the background information and evidence to support the actions outlined in this framework.

It is expected that partnerships and regular consultation will occur where the roles and responsibilities of different organisations intersect across similar objectives. Tobacco control is an issue that confronts all Territorians therefore the responsibility for achieving the objectives that are outlined in the framework rest with all sectors of the community; from government departments to health professionals, non-government organisations and individuals. In addition, the Northern Territory Government remains committed to working closely with other Australian Jurisdictions to share best practice including resources in tobacco control.

By the end of 2009, through initiatives within this framework, the Territory can hope to see significant improvements in the health of all Territorians and a reduction in the social costs and inequalities caused by tobacco in all its forms.

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1. 2.

National Tobacco Strategy 2004-2009 Health Gains Planning Fact Sheet 2. December 2006

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OVERVIEW

Aim The object of this Framework is to provide a framework in which the development of strategies to reduce the harm to people's health from the consumption of tobacco and other smoking products can be developed and implemented.

The Framework provides for 3 key area of focus:

(a) Discouraging people from smoking;

(b) Reducing people's exposure to environmental tobacco smoke; and

(c) Supporting people to stop smoking.

Framework Areas: • Smoking Cessation; • Education and Awareness Raising; • Research, Evaluation and Monitoring; • Resource Development; • Legislation and Policy; and • Indigenous Focus

Primary Outcomes Through the range of actions outlined in this document, the key outcomes of the National Tobacco Strategy 2004-2009 will be achieved. These are as follows:

• Reduced uptake; • Increased cessation; • Reduced exposure for non-smokers; • Reduced harm from use of and dependence on tobacco; and • Equity- reductions in the above particularly among Indigenous Territorians where smoking

prevalence far outweighs non-Indigenous smoking rates.

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1 SMOKING CESSATION Smoking is not a free and informed choice, it is a drug of addiction and should be treated as such.

Appropriate services and treatments for smokers are essential to ensure all smokers have access to support and affordable pharmacotherapies if they decide to quit. The implementation of interlinking policies and programs is also needed to ensure all smokers in contact with the health care system and health professionals are identified and advised to quit, particularly pregnant women and new parents, chronic disease sufferers and other high risk groups

Objective: 1. Improve promotion and accessibility of resources and services to assist smokers to quit. 2. Increase public awareness on the health risks of smoking

Recommended Actions: • Promote national accredited training programs to equip health professionals and allied

workers to plan and deliver smoking cessation programs; • All smokers accessing the health system identified, assessed and offered treatment; • Increase referrals to the Quitline through further promotion and distribution of referral forms; • Incorporate effective interventions for smoking cessation into undergraduate training of

Aboriginal Health Workers; • Correctional facilities and mental health services to develop and implement best practice

policy on smoking cessation and smokefree areas; • Referral of heavily dependant smokers to more intensive Quit counselling with close

monitoring; • Continue to provide a Quitline to all Territorians; • Monitor Quitline to determine effectiveness, efficiency and results; • Conduct a review to determine most effective, efficient and accessible way to provide

cessation services, particularly to high risk target groups in clinical and community settings; • Develop DHCS policy on Nicotine Replacement Therapy (NRT) and availability.

Smoking Prevalence in the Northern Territory remains at approximately 27% compared to 17.4% nationally. The following table outlines smoking prevalence patterns in the Northern Territory: (National Drug Strategy Household Survey 2004)

14-19 20-29 30-39

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40-49 50-59

Males NT

• Females NT

60+

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2 EDUCATION AND AWARENESS

RAISING

You wouldn't give a child a smoke, so why an unborn child?

Most current smokers didn't make an adult and informed choice to smoke as experimenting with cigarettes usually begins before the age of 18 years with little realisation nor care for the level of addiction and health implications that follow.

For this reason, young people are a priority group but parents, teachers and carers have the most important role in educating youth in the dangers of tobacco both directly and simply by being positive role models and not smoking themselves.

OBJECTIVES:

1. To decrease the smoking rates of young people 2. To decrease the uptake of smoking by youth 3. Ensure the community are well informed about related health issues from smoking 4. To educate the community about the support and resources available

Recommended Actions: • Conduct media and other campaigns and programs to encourage people to quit; • Inform the public about the harmful effects of active and passive smoking and benefits of

quitting through a wide range of sources; • Incorporate smoking cessation education into all antenatal classes, both Government and non

Government in.eluding evidence regarding the use of pharmacotherapies during pregnancy; • Localise national campaigns such as using local patients as champions, local launch events

with key personnel etc; • Include tobacco control information or strategies in other programs where there is potential for

joint benefit • Support a range of activities that de-normalise smoking; • Advocate for 'early years' interventions that address parental smoking and other parenting and

environmental issues that influence the uptake of smoking; • A complimentary education, environment policy and community approach to be implemented

in schools;

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3 RESEARCH, EVALUATION AND MONITORING

1 in 5 Territorians who smoke will die as a result of their addiction

The National Tobacco Strategy 2004-2009 is the overarching national guide for tobacco control in Austra lia. It provides a wealth of information and evidenced based strategies supporting the local actions outlined in this strategy

However, continued research, evaluation and monitoring is essential to ensure the actions outlined in this strategy remain evidenced and best practice based and succeed in meeting the aims and objectives.

OBJECTIVES: To ensure that all promotion activities and treatment services are evidence based, clinically proven and evaluated regularly.

Recommended Actions:

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• Assess the attitudes regarding the health effects of smoking among Indigenous Territorians; • Monitor the Indigenous proportion of callers to the Quitline and success rates at 12 week

follow up; • Collect sales data on tobacco use in remote community stores to monitor use; • Collect smoking prevalence data from mental health wards/clinics in the Northern Territory,

both patients/clients and staff; • Pilot smoking cessation courses in Indigenous communities with subsidised / free

pharmacotherapy made available; • Compliance monitoring of tobacco retailers regarding display restrictions and sales to minors; • Monitor the use of pharmacotherapies by young people; • Monitor combined pharmacotherapies with quit success in heavily dependant smokers, both

male and female and over a variety of age groups and occupations; • Pilot the use of pharmacotherapies to support mental health patients to Quit smoking

particularly the use of a variety of products, both combined and used separately; and • Monitor Second Hand Smoke exposure and compliance with the Act in public and VJOrk places

in order to assess the adequacy of current provisions for protecting employees.

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4 RESOURCE DEVELOPMENT 3% of all hospital admissions are attributed to tobacco smoking

Where effective resources currently exist to address particular issues, there is no need to redevelop more. Rather, sharing information and resources with partner agencies, both Government and Non Government is not only appropriate but cost effective enabling funding to stretch to additional action areas.

However, there are resources that must be developed in the Northern Territory in order to effectively communicate issues to various target groups whether gender specific, culturally appropriate, youth targeted etc. For example, Indigenous resources successfully used in other states and territories of Australia do not necessary relate to Northern Territory cultures in terms of artwork, messages, language and culture. These are all issues that must be carefully and locally addressed with key partners/stakeholders.

OBJECTIVE: Improve promotion and accessibility of resources and services by health and education staff.

Recommended Actions:

• Develop Indigenous resources for brief intervention; • Ensure all Indigenous resources are culturally appropriate, adaptable for different languages

and suitable for men and women; • Work to empo'Ner local youth to speak out against tobacco and establish new policy and

campaigns; • Utilise existing resources to inform women of specific issues such as 'Neight gain, smoking

while using a contraceptive drug, fertility, female specific cancers; • Provide fact sheets available detailing pharmacotherapy options, recommendations of use,

combination evidence, use during pregnancy etc; • Smoking and pregnancy resources available for all health staff working with pregnant women

to address the issue; and

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5 LEGISLATION AND POLICY

The Tobacco Control Act 2002 was introduced in January 2003 providing a sound legislative framework to address tobacco control. Since its introduction, all indoor public places and workplaces are smokefree except licensed premises. Tobacco retail restrictions include the requirement of a licence, point of sale signage and further display restrictions. Penalties are higher and the provision to issue infringement notices was introduced.

Tobacco control legislation and enforcement of the lavvs is recognised as an essential strategy among a range of other strategies to reduce tobacco related harm in the community.

OBJECTIVE: 1. Ensure compliance in Tobacco Control Act in regard to smoke free areas 2. Monitor and enforce all aspects of tobacco legislation including the application of best practice

approaches to sale to minors, smoke free workplaces and smoke free public places

Recommended Actions:

• Continued coordination of enforcement activity across the three key agencies, Department of Health and Community Services, NT WorkSafe and Racing, Gaming and Licensing to address smoking and non-smoking areas;

• Monitor environmental tobacco smoke and compliance with the Act with a view to assessing the adequacy of provisions to prevent public and employee exposure;

• Establish and promote a clear smoke free policy for all health service facilities; • Continued enforcement of the law on sales to minors and sale/supply of single cigarettes; • Investigation into the introduction of new tobacco products marketed to children and

prevention methods such as legislation, condition of tobacco licenses; • Monitor, follow up and record all complaint details; • Strengthening of tobacco retail licence conditions particularly if breaches of the legislation

have been found to exist on the tobacco licensed premises; and • Monitor the legislation and policy of other Australian jurisdictions against the NT situation.

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6 INDIGENOUS FOCUS Using tobacco is not part of Indigenous culture, it's poison ...

Research shows that Indigenous Territorians smoke at much higher rates than Non-Indigenous Territorians and that the two leading causes of death and disability are circulatory and respiratory disease. The wider social issues contributing to high smoking prevalence among this group reinforce the need for a collaborative approach with many partner agencies.

Objectives

• To reduce the prevalence of tobacco smoking uptake among Indigenous Territorians; • To increase the proportion of Indigenous Territorians who have never smoked or chewed; • To increase cessation rates of smoking among Indigenous Territorians; • To increase the number of culturally appropriate tobacco resources; • To increase and support local initiatives for smoke free areas/buildings/homes; and • To increase the capacity for the community to actively contribute to tobacco control at the local

level.

Recommended Actions

• Development of appropriate resources that are developed through consultations with Indigenous peoples/groups/communities;

• Support remote communities to Quit through development of revised Fresh Start course; • Provide appropriate and relevant brief intervention training for Aboriginal Health Workers and

other Community members; • Utilise existing Indigenous TV commercials to support any further Indigenous media

campaign/s; • Develop research data into relationship between Nicotine Replacement Therapy and

Indigenous Peoples; • Support Remote Communities to address their concerns with tobacco use through a range of

strategies; • Support remote communities with enforcement of the Tobacco Control Act 2002; and • Support remote communities to develop and implement local no smoking policies and

activities through financial assistance.

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Useful Links

Northern Territory Quitline 13 7848 / 13 QUIT

Smoking in the Northern Territory Health Gains Planning Unit Fact Sheet 2 December 2006 www.nt.gov. au/health

Northern Territory Smokefree website www.smokefree.ntgov.au

Oxygen (youth anti-smoking website) www.oxygen.org.au

National Tobacco Strategy www.nationaldrugstrategy.qov.au

World Health Organisation Framework Convention on Tobacco Control www.who.int/tobacco/framevvork/en/

Central Australian Aboriginal Congress www.cuzcongress.com.au

Centre of Excellence in Indigenous Tobacco Control www.ceitc.org.au

Northern Territory Tobacco Holtine 1800 888 564

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