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What’s fairness got to do with it?

What’s fairness got to do with it?. Session outline. What makes smoking a social justice issue What we have done How it has gone/What the results have been Questions. “Any marker of disadvantage that can be envisaged, whether personal, material, or cultural, is likely to have an

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What’s fairness got to do with it?

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  1. What’s fairness got to do with it?

  2. Session outline • What makes smoking a social justice issue • What we have done • How it has gone/What the results have been • Questions

  3. “Any marker of disadvantage that can be envisaged, whether personal, material, or cultural, is likely to have an independent association with cigarette smoking” Jarvis and Wardle, 2006

  4. Smokingrates - disadvantage AIHW, 20011; ABS, 2008; Morgan, Wattereus, Jablensky et al., 2011; Lawrence, Mitrou & Zubrick, 2009;

  5. Smoking careers Graham et al, 2006 • Childhood • Childhood adversity • Adolescence • Early school leaving • Low educational attainment • Adulthood • Poor adult circumstances • Early mothering • Single parenting Heavier Smoking Persistent Smoking Reduced Quitting Increased Uptake

  6. Causes of preventable deaths, Australia 2003 Reference: Australian Institute of Health & Welfare 2007

  7. The bottom fifth of households were • spending nearly a fifth (18.5%) of their total • household income on smoking

  8. Financial impacts • Less money for essentials like food, accommodation • Smokers twice as likely to report severe financial stress (going without meals, no heating) • Children in smoking households more likely to experience food insecurity • Smokers with serious mental illness spending from one quarter to one third of income on cigarettes Sources: Siahpush et al, 2003; Siahpush et al, 2005; Cutler-Triggs et al, 2008; Steinberg et al, 2004; Lawn, 2001

  9. Tackling Tobacco Program • Phase 1: 2006 to 2011 • Phase 2: 2012 to 2015 • Purpose: • reduce smoking-related harm among the most disadvantaged in NSW, via non-government social and community service organisations (SCSOs) • Aim: • Build capacity of SCSOs to address smoking and support clients to quit • Make smoking care part of usual care • Defining feature: • Presenting smoking as a social justice issue

  10. Why the community sector? • Reach - Large sector (5800 organisations; 335 000 staff) - Already working with disadvantaged populations • Regular, continuing contact • Holistic concern for client’s well-being • Experience and skill to support behaviour change • Flexibility and capacity for innovation • Room for development

  11. Main target groups • Aboriginal people • Low-income families with dependent children • Vulnerable young people • People with severe mental illness • People experiencing homelessness • People with drug and alcohol problems • GLBT people

  12. What we did - engagement • About awareness • raising/persuasion • Briefings and meetings with • senior staff and service • managers • Special workshops and • seminars, conferences • Information resources (E.g. • facts sheets)

  13. What we did – capacity building • One day Smoking Care Training • General • Mental health specific • Delivered to 1600 staff in over 450 organisations/services • Resources • Policy • Individual case work • Group work

  14. What we did- resourcing and support • Financial and other support for smoking care projects • Funding amounts ranged from $30 000 to $5000 • Have supported around 85 projects involving more than 110 organisations Project activities: • Policy review • Provision of Training • Develop tools and resources • Provide client support to quit • Provide staff support to quit • Most provided free NRT

  15. Findings from Tackling Tobacco

  16. Cross sectional survey of community sector organisations - 2009 Aim: - Get a clearer picture - how receptive? current activity? - Establish baseline to measure any progress • Sample of 142 organisations (drawn from peak agency • data base) • Surveys completed (n = 149) with staff from 93 (65%) • organisations (senior staff, managers, other staff) • Questions explored: • Attitudes and beliefs regarding smoking • Organisational and service policy on smoking • Smoking care practice Bonevski, et al., 2012, under review

  17. Policy coverage Bonevski et al., 2012, under review

  18. Staff smoking care practices n =149 Bonevski et al., 2012, under review

  19. Smoking care training evaluation • Project funded by NSW Health Department • Provided smoking care training to 600 community sector and health department staff • Smoking and disadvantage, brief intervention skills, use of NRT, managing relapse etc • 600 staff participated the training • Pre and post design (questions on attitudes to smoking and provision of smoking care; confidence in providing smoking care; delivery of different aspects of smoking care) • Pre survey completed by 442 staff(74%) • Post survey at 3-month phone follow up, completed by 306 staff (51%) O’Brien et al., 2012, in press

  20. Staff confidence levels pre and post training Pre and post training survey (n =306). All changes significant at p<0001 O’Brien et al., 2012, in press

  21. Self-reported staff behaviour (often/always) at pre-training and 3-month follow up (n=306) All comparisons significant at p<0.0001 O’Brien et al., 2012, in press

  22. Findings from project evaluation • Community initiative Scheme projects x 20 (funding $4000-$30 000) • Smoking care projects x 51 (funding $5000-$10 000) • Other individual projects • Mixed method evaluation. Findings drawn from: • Project reports • Document review • Quantitative surveys • In depth interviews with project staff • Focus groups with both clients and staff Hull et al., 2012, under review

  23. Changes to policy/protocols Move from minimal to more comprehensive Policies : • Creating/moving designated smoking areas • Changes to staff smoking with clients • Support for clients/staff to quit • Asking about and recording smoking status “Our policies remain unchanged but our practice is now in line with them” Hull et al., 2012, under review

  24. Changes to culture “ The ‘Be Smoke Free’ program has led to a culture of support at The Wayside Chapel where quitting is on the agenda and all are welcomed and encouraged to participate” (Inner city service for homeless) “It is much needed, long overdue, and is going a long way to shift a deeply entrenched culture and support People whose lives are so severely affected by tobacco addiction” (Mental health service)

  25. Outcomes for clients • Quitting • Limited data but people (clients/staff) have • quit/cut down/made quit attempts • Benefits for clients • More money – improved quality of life • Improved fitness and mental health • Better self care • More freedom Hull et al., 2012, under review

  26. John’s story – Mission Australia Living with schizophrenia Enrolled in cessation project Greatly reduced smoking using combination NRT Saved significant money Bought better food – eg fish Lost 35kg Joined NSW art gallery Took TAFE art courses Enjoying life!

  27. Tackling Tobacco – overall findings • Community services can do this • work • Assumptions have been • challenged • Easy access to affordable NRT is • a catalyst • Nothing bad has happened • Clients’ quality of life has • improved

  28. Challenges for the next phase • Going wider - other sub-sectors • Going deeper - demo sites to demo organisations- changing systems • Continuing attitudinal barriers • Access to affordable NRT • Engaging government support • Better client outcome data

  29. What you can do • Ask • Support • Refer • Advocate • What we offer • Free resources • Smoking care training (limited at the moment) • Advice and support

  30. Tackling Tobacco related websites Cancer Council NSW Tackling Tobacco pages http://www.cancercouncil.com.au/1384/reduce- risks/smoking-reduce-risks/tackling-tobacco/ Ask the question- Tackling Tobacco training and resources http://www.askthequestion.com.au/

  31. Acknowledgements Colleagues: • Especially Phil Hull, Allison Salmon, Wendy Oakes, Kelly Williams, but all who have had a role in Tackling Tobacco Research partners at Newcastle University: • Billie Bonevski, Jamie Bryant and Chris Paul Clients, staff and volunteers in community organisations: • All those who saw in Tackling Tobacco a cause that mattered and who got involved

  32. Question for you • What is the most useful or thought- • provoking thing you have heard this • morning? • Your questions?

  33. A final thought • If you knew of a strategy that would provide the people • with whom you work: • A boost to their self confidence and sense of control • Real improvements to their quality of life • An extra 10-14 years of lifespan • Between $ 50 000 and $ 200 000 extra funds available over their lives • ……. Would you use it? • If the answer is yes then help your clients quit • smoking

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