Rethinking smoking among Aboriginal Australians: the harm minimisation- abstinence conundrum

Issue addressed: This is an opinion paper which explores the largely untapped potential that exists to utilise harm reduction principles when addressing smoking by Aboriginal and Torres Strait Islanders. Smoking prevalence among indigenous people is in the order of two to three times as great as that found in non-indigenous communities. Smoking impacts greatly on overall health status and hence is a major contributor to the poor health status of many indigenous people. Methods: Key characteristics of smoking, including both its addictive nature and its adaptive and functional role, are summarised. In particular, motivators and reinforcers for uptake and continuation of smoking by Aboriginal people are discussed. Emphasis is placed on issues of loss and the negative connotations of traditional public health messages entailed in cessation strategies. Aboriginal perspectives on health and their relevance to smoking are outlined. Elements of harm reduction approaches to drug use generally are described. Conclusions: Harm reduction strategies have been little tried in relation to smoking. Given the dire need to address the extremely high levels of smoking and their negative health consequences for indigenous people, it seems that harm reduction approaches may have much to recommend them with these groups in particular. So what? Although largely untested, harm reduction approaches to smoking with indigenous people may have more to offer than traditional approaches. Better outcomes may be achieved by the application of a wider, more flexible array of approaches than previously considered. (author abstract)