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Thursday, 13 September 2012

Tobacco use Reduction - A Need to target high use groups: Chronic Mentally Ill and Aboriginal populations

Irrespective of where you are in the country you must have noticed the dramatic decline in public smoking in the last decade.  While the cliques of smokers still mingle, their enclaves have moved from the front door to the side, and fewer individuals congregate over the coveted ritual of tobacco smoke inhalation.   Though unlikely to be designated an endangered species yet, smokers have moved from the mainstream to the sidestreams. 

With such profound cultural change having occurred, and a consistent half to one percent absolute reduction in smokers per year, tobacco reduction professionals need to be thinking more about how to support success.  Two specific groups have been resistant to reducing use of the weed; those with chronic mental illness and the Canadian Aboriginal population. Depending on the area of the country, these populations may represent 25-50% of the smoking population.  

It is timely that Cochrane published a review of effective practices on tobacco prevention for Indigenous Youth Cochrane review of smoking prevention in Indigenous Youth

Disappointing was that only two studies were identified, neither of which demonstrated effectiveness of their interventions. 

A NEJM editorial from a year ago looked at the issue of smokers with mental illness NEJM July 2011 smoking and mental illness and provides a succinct tabulation of effectiveness of interventions. 

If we are going to continue to reduce tobacco consumption in Canada, more of the same will have some effects, but targeting those groups with known elevated tobacco consumption rates will be needed as the final push to making smokers an endangered species is being made.  

Key in making tobacco history is going to be efforts that specifically determine how to increase successful reduction efforts for these two populations.  The first step may be better user engagement and demonstration that tobacco is a significant concern.   For those with mental illness who smoke, life expectancy can be shortened by 25 years.  Less is documented on the direct impact of smoking on Canadian Aboriginal peoples with the lack of information likely a barrier to describing the problem.  

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