Be Our Ally Beat Smoking (BOABS) Study
Aboriginal people smoke at much higher rates than non-Aboriginal people and smoking is an important contributor to increased disease, hospital admissions and deaths in Aboriginal populations.
Quit smoking programs in Australia have not had the same impact on Aboriginal smokers as on non-Aboriginal smokers. It is important that improved techniques for assisting Aboriginal people to quit be developed and implemented as part of comprehensive strategies to improve Aboriginal health.
A range of strategies have been used to encourage Aboriginal people to quit smoking however there have been few good quality studies that show what approaches work best. More evidence of strategies that could work more widely in Aboriginal primary health care settings is needed if good policy is to be developed and implemented.
We conducted a NHMRC funded randomised controlled trial of smoking cessation strategies in Aboriginal community controlled health services (ACCHS) in the Kimberley. This trial was based in Derby Aboriginal Health Service (DAHS) and Ord Valley Aboriginal Health Service (OVAHS).
The BOABS Study was carried out by local, trained Aboriginal Research Staff based at DAHS and OVAHS. Participants who agreed to take part were randomly allocated to either a program following current Australian recommended primary care smoking cessation strategies (usual care) or a more intensive supported quit smoking intervention (outreach).
We found that:
- 11% of the outreach group had quit smoking at 12 months – more than twice the quit rate of the group who received usual clinic care.
- A meta-analysis of these findings and a comparable study of pregnant Aboriginal and Torres Strait Islander women showed that Aboriginal and Torres Strait Islander participants assigned to the intervention groups were 2.4 times (95% CI, 1.01-5.5) as likely to quit as participants assigned to usual care.
Challenges we encountered during the relatively complex BOABS Study included:
- Complexities in conducting a randomised controlled trail such as recruiting sufficient number of participants and managing the project in two distant locations.
- Providing appropriate training and support to Aboriginal researchers and ensuring high quality work across both sites.
- Significant staff absences, staff shortages and high workforce turnover.
- Determining where and how the project fitted in the clinics; resistance to change, and maintaining organisational commitment and priority for the project.
The keys to the success of the BOABS Study were:
- Local development, ownership and participation.
- Worker professional development and support.
- Operating within a framework of cultural safety.
Culturally appropriate, multi-dimensional Indigenous quit smoking programs can be successfully implemented in remote primary health care. Intensive one-on-one interventions with substantial involvement from Aboriginal and Torres Strait Islander workers are likely to be effective in these settings.
Research to investigate complex interventions in Aboriginal health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. The questions now should be whether real world smoking cessation programs work in practice, whether they are cost effective and sustainable and to identify enablers and barriers to the integration of such programs into primary health care for Aboriginal and Torres Strait Islander peoples.
The priority should now be to implement and integrate a smoking cessation program, based on BOABS, within usual primary health care in the Kimberley and to demonstrate the effectiveness of this program to support people to quit smoking in a real world setting.
Julia V Marley, Tracey Kitaura, David Atkinson, Sue Metcalf, Graeme P Maguire and Dennis Gray. Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study. BMC Public Health 2014; 14:579
Julia V Marley, David Atkinson, Tracey Kitaura, Carmel Nelson, Dennis Gray, Sue Metcalf, and Graeme P Maguire. The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health 2014; 14:32
Julia V Marley, David Atkinson, Carmel Nelson, Tracey Kitaura, Dennis Gray, Sue Metcalf, Richard Murray and Graeme P Maguire. The protocol for the Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health 2012; 12:232
- Tracey Kitaura
- Prof David Atkinson
- Prof Dennis Gray
- Assoc Prof Graeme Maguire
- Assoc Prof Julia Marley
- Sue Metcalf
- Assoc Prof Richard Murray
- Dr Carmel Nelson
- Sue Clarke
- Edna Hester
- Brian Hunter
- Brett Nelson
- Bevan Norman
- Marian Lester
- Keran List
- Tara Page
- Alaine Ross
- Veronica Ryder
- Roxanne Williams