BREATHE

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					                                                               BREATHE
                                                                 Building Research Evidence
                                                                                                            to address
                                             Aboriginal Tobacco Habits Effectively
BREATHE Project
Tobacco smoking is a highly prevalent health risk behaviour within Aboriginal communities in NSW and an identified
priority area that requires action to reduce morbidity and related mortality for Aboriginal people.
The Aboriginal Health and Medical Research Council of NSW (AH&MRC) is currently implementing a Tobacco Control
Research Project – the BREATHE Project - with 12 Aboriginal Community Controlled Health Services (ACCHSs) in
NSW. The project is being funded primarily by the Australian Respiratory Council, with funding also being provided by the
Cancer Council of NSW and the National Heart Foundation. The AH&MRC project partners are the Cancer Council of
NSW, the National Heart Foundation, the Sax Institute, NSW Health and 12 participating ACCHSs. Technical support is
being provided by individuals with expertise in Aboriginal Tobacco Control (Dr Rowena Ivers) and through the National
Centres for HIV Social Research and HIV Epidemiology and Clinical Research.
It is anticipated that this project will increase the capacity of ACCHSs to implement local tobacco control activities and
programs, and will also provide high quality evidence to inform future Aboriginal tobacco control program and policy
development.
The Project
The project will trial an innovative tobacco control and smoking cessation program in a range of ACCHS settings involving
a specialist Tobacco Control Worker and a coordinated program of enhanced support.
The project aims are:
• To increase the capacity of ACCHSs and their staff to deliver smoking cessation initiatives to Aboriginal people in
   NSW communities (including through brief interventions, QUIT groups, increased access to affordable nicotine
   replacement therapies) and to implement and facilitate tobacco control activities in NSW Aboriginal communities;
• To increase readiness to quit, number of quit attempts, and successful quit attempts amongst Aboriginal people in NSW
   communities;
• To contribute to the evidence base surrounding smoking issues and interventions in an Aboriginal community context;
• To develop a smoking cessation and tobacco control program that is sustainable and transferable to other ACCHSs.

Study Design
The design of the BREATHE Project is a community-randomised controlled trial, where six of the 12 participating
communities have been randomly selected to receive the intervention. This will allow the impacts of having a specialist
Tobacco Control Worker in an ACCHS to be compared with an ACCHS that continues with usual care. The overall design
is illustrated in Figure 1.
                                                                                          Figure 1: BREATHE project design


                                                    12 Participating
                                                        ACCHSs




                                                  Baseline data collection




                                                       Randomisation




               6 Intervention sites
                     ACCHSs
                                                                                            6 Control sites
                       with                    12 month intervention period
                                                                                         offering usual care
                Tobacco Control
                     Workers




              Post intervention data                                                    Post intervention data
                     collection                                                                collection




The intervention
Each intervention site ACCHS will receive:
•   substantial funding towards the employment of a specialist Tobacco Control Worker (TCW).
•   access to training and support for the TCW
•   support for the provision of Nicotine Replacement Therapies (NRT)
•   support to develop and implement a site-specific Tobacco Control Work Plan of evidence-based tobacco control activities
The Tobacco Control Worker will be supported by the Project Team, the Project Management Group and partner
organisations, with support including:
•   Information about evidence-based practice and models of best practice in tobacco control and smoking cessation relevant
    to an Aboriginal community context
•   Access to formal training about tobacco control and to build skills to undertake advocacy work. A training module is
    being developed and will be piloted, based on existing smoking cessation and tobacco control training packages. It is
    planned to explore options to ensure the developed training package will be useable for future Aboriginal Health Worker
    training and up-skilling in smoking cessation tobacco control
•   Specific support to improve the inclusion of smoking cessation and tobacco control activities into policies of the
    ACCHS and other community organisations;
•   The development of a network between Tobacco Control Workers in intervention sites, with regular quarterly face-to-face
    meetings and other contacts.
Project evaluation
The evaluation will include:
• documentation and measures of the Project’s implementation and reach
• assessment of the impacts of the intervention through baseline and post-intervention assessment of:
   - ACCHS staff knowledge and practices
   - ACCHS systems and capacity relating to assessing smoking status and delivering smoking cessation interventions
       including NRT
   - Content and implementation of tobacco control policies and procedures at ACCHSs and other Aboriginal
       community organisations
   - Smoking-related knowledge and behaviours amongst Aboriginal community members
• Comparison of the nature and magnitude of changes at intervention sites with those at control sites
• Analysis of possible contributing factors to sites of relatively high levels of impact
Separate evaluation methods will be developed for ACCHS Quit groups and for site specific health promotion projects and
other smoking cessation and tobacco control activities.
Project Governance
The project reports to the AH&MRC Board of Directors, and also provides periodic project updates to the funding bodies.
Communication with all the participating ACCHSs will occur on a regular basis.
A Project Management Group (PMG) with membership from project partners meets bimonthly.
Dr Jenny Hunt             AH&MRC                              Andy Mark                NHF
Rodger Williams           AH&MRC                              Julie Anne Mitchell      NHF
Sean Appoo                AH&MRC                              James Ward               NCHECR
Anita Tang                TCCNSW                              Sandra Eades             The Sax Institute
Jon O’Brien               TCCNSW                              Rowena Ivers             University of Wollongong
Tracey Greenberg          Quitline/NSW Health
In addition, a Community Reference Panel is being convened to provide expert advice from Aboriginal communities to the
project.
Progress to date
The BREATHE project has received all the necessary approvals, and baseline data collection has begun. Recruitment efforts
for the Tobacco Control Workers at intervention sites will start soon, and the intervention period will commence after
successful recruitment in early 2009.
For further information please contact:
Dr Jenny Hunt                                                        Sean Appoo
Public Health Medical Officer and Chief Investigator        BREATHE Project Manager
jhunt@ahmrc,org.au                                                   sappoo@ahmrc.org.au

				
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