‘It had to be my choice’ Indigenous smoking cessation and negotiations of risk, resistance and resilience

Abstract

While Australia is considered a world leader in tobacco control, smoking rates within the Aboriginal and Torres Strait Islander population have not declined at the same rate. This failure highlights an obvious shortcoming of mainstream anti-smoking efforts to effectively understand and engage with the socio-cultural context of Indigenous smoking and smoking cessation experiences. The purpose of this article is to explore the narrative accounts of 20 Indigenous ex-smokers within an urban community and determine the motivators and enablers for successful smoking cessation. Our findings indicated that health risk narratives and the associated social stigma produced through anti-smoking campaigns formed part of a broader apparatus of oppression among Indigenous people, often inspiring resistance and resentment rather than compliance. Instead, a significant life event and supportive relationships were the most useful predictors of successful smoking cessation acting as both a motivator and enabler to behavioural change. Indigenous smoking cessation narratives most commonly involved changing and reordering a person's life and identity and autonomy over this process was the critical building block to reclaiming control over nicotine addiction. Most promisingly, at an individual level, we found the important role that individual health professionals played in encouraging and supporting Indigenous smoking cessation through positive rather than punitive interactions. More broadly, our findings highlighted the central importance of resilience, empowerment and trust within health promotion practice.

Keywords:

• public health
• stigma
• risk
• trust
• Indigenous
• smoking cessation
• smoking

Notes

1. The term Indigenous is used to refer to Aboriginal and Torres Strait Islander people and the authors acknowledge that Aboriginal and Torres Strait Islander peoples comprise of two distinct cultural groups.

2. Brisbane is the capital city of Queensland, Australia.

3. The reserve system involved the separation of Aboriginal and Torres Strait Islander people from Australian society during the late nineteenth century to the 1960s into discreet and isolated communities. Government-appointed administrators were able to exercise control over most aspects of everyday life.

4. QuitLine is a telephone service which provides support and encouragement for smokers who want to quit.