Essay: Smoking Among Aboriginal Teens In Australia - Causes & Recommendations.

Reason for the teenagers of aboriginal population being vulnerable to smoking

Discuss WHY your chosen population is considered vulnerable and include:
o Social determinants of health and how they impact this population;
o Health inequalities (the differences in health status between population groups) such as differences in wellbeing, risk of disease, abuse/violence, healthy life expectancy, morbidity and mortality;
o Health inequities (differences in health status between population groups that are socially produced, systematic in their unequal distribution across the population, avoidable and unfair) such as difference in access, affordability, income etc;
o Health outcomes – Discuss key health issues impacting this population ie certain disease,mental health issues, injuries etc. (approx.1200 words)

• DISCUSS ONE specific health disparity impacting this population:
(Health disparity: difference in access or availability of facilities or services):
o Present relevant evidence that demonstrates that a health disparity exists ie evidence of lack of sexual health clinics in regional/rural and remote areas or no afterhours GP clinic to deliver vaccination for at risk migrant workers. You may use tables or graphs to display this information. Remember these should add to your discussion not replace discussion.

o Describe the impact on health that includes consideration of the relevant social,environmental, economic, and cultural factors. Ie. Higher incidence of STIs such as chlamydia in the LGBQTI population related to safe sex practices and risk factors specific to this group. This is further exacerbated by poor attendance to healthcare facilities for fear
of discrimination by healthcare professionals. Here you can make educated links between the cascading effects a health disparity can have on a range of health issues. For example the lesbian client who does not feel comfortable attending the GP for sexual health checkups is also isolated for other preventative health screening such as cervical screening or breast checks, increasing her risk of undiagnosed breast or cervical cancer.

• Identify a target audience in a position to make policy decisions or allocate resources for this population. This may be related to allocating resources or funding, approving services,implementing practice changes, or agreeing to a collaborative partnership. Such as a local Foundation, a School Board, the Health Department, a Board of Directors or group of Trustees. Make a rationale for your choice: why does this audience have proven decision making abilities
with regards to the chosen population?

OR if you discover that resources or practices are currently available but not well utilised discuss how these could be used to promote better health equity and equality for your chosen vulnerable population AND
• Propose specific recommendations for a project to this audience who are in a position of making decisions to improve health outcomes for the specific health disparity within this population OR conversely build capacity. These recommendations should include the role of a nurse in achieving better health outcomes and be supported by research that they will have some impact.

Such recommendations could include nurse led clinics, education sessions, targeted screening,changing practice (more accessible facilities, services or better trained staff). Be specific about how your recommendations will attempt to overcome the health disparity you highlight and how these may achieve improved health outcomes for this group.
Example: improved mental health access for new refugees in regional areas by case workers.

Referrals to mental health nurse practitioner within GP clinics will improve access. Research shows improved mental health outcomes when there is early identification of depression, anxiety or posttraumatic stress disorder in refugees (citation). Improved mental health access to a qualified professional leads to better management of mental health issues that may impact quality of life,especially with ability to obtain work and maintain personal and family relationships (citation).

For ideas on innovative nurse led programs and clinics that are already providing care to vulnerable populations and providing valuable services check out the Australian Primary Health Care Nurses Association:
• To conclude, make a descriptive statement that links your recommendations to one of the Standards for Practice for Registered Nurses (2016). In your statement include the standard you feel your exploration of this group links with your ability to achieve person centred care AND why it is important to advocate for vulnerable populations as nurses. For example: Providing specific sex health education to LGBQTI teens could link to Standard 3.2: provides the information and education required to enhance people’s control over health. 

Smoking is the cause of a number of major to minor illnesses. This is why a number of countries have banned tobacco or implemented suitable policies to reduce the number of smokers such as restricting the sale and import of tobacco related products. However, total number of such countries is very low. In Australia, smoking is prohibited in enclosed public places, workplaces, covered areas of public transport stations or stops, enclosed areas of clubs and pubs, and outdoor areas of underage events. Smoking is a serious concern in Australia. But a more serious concern has arrived which is teenage smokers. Although, selling tobacco products to a minor is illegal in Australia, the problem is rising day by day.

Especially, among teenage population of aboriginal people, the number of chain smokers is very high. Aboriginal people migrated in Australia from Asia thousands of years ago (minimum 30,000 years). Since then, 2% of total population of Australia consists of aboriginal people (Gray & Tesfaghiorghis, 2018). Smoking rates is higher among teenagers belonging from aboriginal population. It is a matter of concern as it is found that the smokers who started smoking at an early age are less likely to quit smoking in their adulthood and more likely to smoke heavily. In this report, the reasons behind high rates of smoking among teenage population of aboriginal people will be discussed. Recommendations to improve the situation will be provided followed by thorough analysis of relevant factors associated with smoking.

2. Reason for the teenagers of aboriginal population being vulnerable to smoking

The chosen group (i.e. teenage aboriginal population) is vulnerable due to some underlying reasons which are to be discussed in following sections.

2.1 Social determinants of health

The smoking rate among aboriginal population in Australia is relatively higher. Especially, the teenagers (12 years to 18 years) consume tobacco in a significantly high rate. While assessing the reasons for the same there are a number of factors which causes aboriginal teenagers to smoke. One of major reasons behind high smoking rate among teenage population of aboriginal people is stress (Dudgeon, Wright, Paradies, Garvey & Walker, 2014). Stress, as it is known, is a problem from which most of the world population is suffering. The aboriginal population of Australia is no exception. When it comes to teenagers belonging from this community, it can be said that they also suffer from excessive stress.

The stress can be caused from financial crisis in family, homelessness, inability to access proper education, social discrimination etc. Therefore, the teenagers of aboriginal population tend to suffer from stress to alleviate which they opt for smoking. Smoking is considered as a calming agent that calms down the mind and relieves tension. The Australians have agreed that smoking relaxes them whenever they are stressed or depressed. Hence, psychological factors contribute to smoking of the aboriginal teenagers. Addiction is another reason. Smokers agree that smoking is an addictive habit. When someone starts smoking at an early age, that individual is unable to stay away from cigarettes; as a result, the individual starts heavy smoking.

Social determinants of health

It has been earlier said that a smoker starting at an early age is more likely to smoke heavily and also less likely to quit the habit (Jun, 2017). Therefore, a teenager addicted to smoking becomes less likely to give up the habit which increases the number of teenage smokers among aboriginal population. Unemployment is another issue which makes 17-18 years old to smoke. To combat financial crisis, the children from aboriginal population tend to find employment at an early age to support their family. But as the country is fighting employment issues, it becomes hard for them to find job. As a result they suffer from low self-esteem and start to smoke.

As aboriginal people live a tough life, there is at least one smoker in every household of aboriginal population. Therefore, the children grow up in an environment where smoking is a common thing. This allows the teenagers to start to smoke at an early age. They consider smoking as a ‘social norm’ as smoking is referred as a common form of socialising in the community (Rodríguez-Planas & Sanz-de-Galdeano, 2016). Lack of awareness is another reason, most of the aboriginal people do not know about the health issues caused by smoking.

2.2 Health inequalities

Smoking among aboriginal population, teenagers to be precise have increased due to the impact of certain social determinants mentioned in above section. The smokers are mostly males and it is found that health inequalities play a pivotal role in this context. The aboriginal population of Australia is considered as one of the disadvantaged groups of the country (Arjunan et al. 2016). The study shows that one of the major reasons of the health inequality among different socio-economic groups are  Health inequalities such as differences in wellbeing, violence/ abuse, risk of disease, healthy life expectancy, mortality and morbidity etc. are associated to smoking among aboriginal teenagers.

It has been found that mortality and morbidity rates are higher among smokers; therefore, the aboriginal teenagers are under this great threat (Hyde et al. 2018). Violence and abuse are associated with smoking as well. As aboriginal teenagers smoke more, they tend to show act of violence and can become easily agitated. Violence can make a negative impact on a person’s mind. The damage level is higher for children. Every 1 of 4 aboriginal people are likely to come across violence either at home or in their community. This affects the mental wellness of children; therefore, they start smoking. On the other hand, abuse is a cause for which teenagers from aboriginal population are taking up smoking.

With rising cases of child abuse, the children are exploited at an early age, affecting their psychological wellbeing (Hodyl, Grzeskowiak, Stark, Scheil & Clifton, 2014). This can give rise to the teenage smokers in aboriginal population of Australia. Healthy life expectancy is going downwards for the teenagers of aboriginal population post the rise in smoking rate among them. They are having higher level of risk of diseases such as cancer, lung infections etc.

Health inequalities and Health outcomes

2.3 Health inequities

When it comes to smoking, it has a number of significant factors associated with it. Income, access, affordability affects the smoking rate of aboriginal teenagers. It is found that most of the smokers belong from lower income group (Andersen, Kuperman, Long, Gerrard & Philibert, 2017). There is a valid reason behind this. The people from lower income group are struggling each day to ensure their survival in the world. The struggles they go through are aimed to ensure their livelihood. They go through a lot of stress which make them vulnerable to smoking. In such a scenario, teenagers are considered as most vulnerable population.

As a result of adolescence, teenagers become carefree and curious to explore the unexplored. Their curiosity makes them to start smoking which in turn ends up making them chain smokers. It has been reported that young people living in lower socio-economic groups are suffering from illnesses caused by smoking 1.5 times more than the ones living in highest socio-economic groups (Gibberd et al. 2018). As the people of aboriginal population belong from a disadvantaged economic class, it is evident that there will be more number of smokers among them. Also, the teenagers of aboriginal population have easy access to cigarettes as almost every household is having at least one smoker. In such an environment it will be easier for children to get access to cigarettes or tobacco items.

2.4 Health outcomes

Smoking causes a number of health hazards to the aboriginal population. The teenagers of aboriginal population tend to suffer from respiratory problems such as asthma, pneumonia, and Chronic Obstructive Pulmonary Disease (COPD) which are caused by excessive smoking. Respiratory issues are more common in aboriginal teenagers of Australia. Lung cancer is very common among aboriginal population due to their high rates of smoking (Gibberd, Supramaniam, Dillon, Armstrong & O’Connell, 2016). With more teenagers becoming chain smokers, the country is likely to get more number of ill people from their aboriginal population. The chances of being diagnosed with cancer caused by smoking are 3 times higher in teenagers from aboriginal population than that of the rest of the countrymen. 12% of health problems caused to teenagers of aboriginal population are caused from smoking.

3. A health disparity impacting aboriginal population

The health disparities among aboriginal teenage population caused from smoking are wide-ranged. However, the prevalence of respiratory problems like asthma is more common than other illnesses. Lung cancer is found mostly among adults of aboriginal communities due to their long term smoking habits. As the teenagers are relatively newer they tend to develop the issues like respiratory problems first. Although

3.1 Relevant evidence

The teenagers from aboriginal communities are more likely to suffer from respiratory problems because of a number of underlying factors. Teenage is a stage where an individual experiences a wide number of physical and other changes. This is the time when an individual becomes vulnerable to certain things and smoking is one of them. With easy access to tobacco products, the teenagers of this community start smoking at an early age (Garner et al. 2018). Afterwards they encounter a number of health issues one of the most common issue is asthma. It is found that aboriginal people are economically backwards which keeps them from proper education. Low access to education results in lack of proper knowledge regarding health issues, its prevalence, and the consequences (Wright, 2018).

Health inequities

This keeps these people from visiting physicians as they are ignorant about the outcome of a certain symptom which is why they fail to identify health hazards. Once they understand the issue it is already too late to initiate proper treatment. Also, lack of access to proper healthcare facilities are another significant reason of higher mortality rates (Evans-Whipp, Plenty, Catalano, Herrenkohl & Toumbourou, 2015). Low availability of GP clinics is also a barrier to combat asthma and other respiratory illnesses.

3.2 Impact on health

As the teenagers of aboriginal communities do not have proper access to healthcare professionals, this makes a negative impact on their overall health. For example, if a teenager from aboriginal community does not visit doctor after experiencing breathing issues, the problem would worsen due to lack of on-time treatment. This can also result in serious heart problems as well if not treated. Also, a teenager can form a number of other illnesses than respiratory problems. If the teenager is not taken to doctor there is a high probability that the other health issues of that individual will remain untreated. This might lead to further health hazards for that person.

Discrimination is another reason which keeps aboriginal people from visiting healthcare professionals. Due to discrimination they are often deprived of needful health facilities (Freeman et al. 2018). They are unable to get access of health and social care facilities and awareness related to health issues. In such a scenario, the overall health status of them deteriorates, making them more vulnerable to major illnesses. Lack of access to health facilities is a great barrier for the aboriginal teenagers to lead a healthy life (Gould, Watt, West, Cadet-James & Clough, 2016). The issues which keep the aboriginal people from living a healthy life are varied. Being hailed from disadvantaged community of Australia most of the aboriginal people belong from low income group. Financial status is a huge barrier to get proper treatment and education for them.

4. Target audience in a position for decision-making regarding policy or allocation of resources

As it is found that teenagers of aboriginal communities are most vulnerable to smoking caused diseases, it is essential to find out the relevant resources and information which might help to uplift their situation. The schools must take a positive step to tackle this situation. The schools should introduce special education facilities for the children from aboriginal communities. The Government of Australia must allocate funds for the same. Education is the basic necessity of a child, financial barrier or other social barriers (such as, discrimination) must not intervene in this process. To reduce the rate of aboriginal teenagers smoking cigarettes, the Government should pass strict law regarding this.

Selling tobacco products to a minor should be declared as criminal offence in order to combat the critical situation. Indigenous Australian’s Health Programme provides well-structured programmes for chronic diseases which aim for tobacco reduction and promotion of healthy lifestyle activities. Care coordination and outreach workforce are also offered by Indigenous Australian’s Health Programme for GP and health organisations controlled by aboriginal communities. The National Aboriginal and Torres Strait Islander Health Plan 2013–2023 is focused on closing health gaps in aboriginal communities (Wright, Lovett, Roe & Richardson, 2018). Their early childhood initiative addresses underlying social determinants causing poor health. The aboriginal people must know about these programmes and initiatives to give their child a healthy life.

Impact of smoking on mental and physical health

5. Recommendations

To overcome the health disparities it is essential to provide proper education to aboriginal teenagers. They must know about health related factors and their role in developing a particular illness. They should be aware about different diseases and for that healthcare campaigns aimed for aboriginal communities must be launched. The health staff must keep discrimination aside and focus on treating the patients. Nurses should conduct targeted screenings and education programmes for the aboriginal people especially teenagers. The aboriginal population must be encouraged to take up healthy habits and give up unhealthy habits like smoking.

They should use cultural aspects to make them quit smoking. The nurses must be well-equipped with history of aboriginal people so that they can remind them about their traditions and values. This is likely to make deep impact on their mind. Nurses should conduct classes for health related studies as well. Nicotine replacement therapy is highly referred as it can slowly reduce the rate of tobacco consumption among aboriginal teenagers. Electronic cigarette can be considered as a temporary replacement of tobacco (Thomas, Lusis, Van der Sterren & Borland, 2018).

Proper monitoring should be done in order to record the progress. The business organisations of the country should be considerate about giving equal chance to aboriginal people. With flow of education and employment opportunities there will be less stress and smoking rate will take a downfall (Dessaix, Maag, McKenzie & Currow, 2016). Government of Australia should pass strict anti-discrimination law to make the lives of aboriginal people better.

6. Conclusion

The teenage population of aboriginal communities require proper care support and awareness in order to live a healthy life. Nurses play a pivotal role in improving the overall health situation of the aboriginal teenagers. It is necessary for them to link to Standard 1.3: respects all cultures and experiences, which includes responding to the role of family and community that underpin the health of Aboriginal and Torres Strait Islander peoples and people of other cultures ("Nursing and Midwifery Board of Australia - Registered nurse standards for practice", 2018). This standard would be appropriate in this context. As aboriginal people are economically backwards and discriminated, it affects their mental health (Purdie, Dudgeon & Walker, 2010).

As for teenagers, they face discrimination which makes them stressed. Hence, they opt for tobacco as an easy way to calm their mind, being completely ignorant about its negative outcomes. Nurses must lift their spirits up by understanding their culture and providing them with proper knowledge about health. This report has analysed all the relevant factors affecting the teenagers of aboriginal communities. Also, suitable recommendations are provided along with brief explanation which can help in improving the condition of teenagers of aboriginal population in Australia.

References

Andersen, A. M., Kuperman, S., Long, J., Gerrard, M., & Philibert, R. (2017). 6.43 Epigenetic

Evidence of Nascent Smoking Concentrated Among Low Income Youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), S291.

Arjunan, P., Poder, N., Welsh, K., Bellear, L., Heathcote, J., Wright, D., ... & Wen, L. M. (2016).

Target audience for policy decisions and resource allocation

Smoking among Aboriginal adults in Sydney, Australia. Health Promotion Journal of Australia, 27(1), 66-69.

Dessaix, A., Maag, A., McKenzie, J., & Currow, D. C. (2016). Factors influencing reductions in smoking among Australian adolescents. Public Health Res. Pract, 26, e2611605.

Dudgeon, W., Wright, M., Paradies, Y., Garvey, D., & Walker, I. (2014). Aboriginal social,

cultural and historical contexts. In Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (pp. 3-24). Commonwealth Department of Health.

Evans-Whipp, T. J., Plenty, S. M., Catalano, R. F., Herrenkohl, T. I., & Toumbourou, J. W.

(2015). Longitudinal effects of school drug policies on student marijuana use in Washington State and Victoria, Australia. American journal of public health, 105(5), 994-1000.

Freeman, J., Murphy, E., Woolfenden, S., Waters, E., Winters, J., Callaghan, L., & Zwi, K.

(2018). Can a child and family health service improve early childhood health outcomes in an urban Aboriginal community?. Journal of paediatrics and child health, 54(5), 541-545.

Garner, A. J., Robertson, A., Thornton, C., Lee, G., Makris, A., Middleton, S., ... & Hennessy, A.

(2018). Adolescent Perinatal Outcomes in South West Sydney, Australia. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(1), 10-15.

Gibberd, A., Simpson, J., Jones, J., Williams, R., Stanley, F., & Eades, S. (2018). Poor birth

outcomes among Aboriginal Western Australians and smoking, alcohol and substance misuse, and ssault. International Journal of Population Data Science, 3(4).

Gibberd, A., Supramaniam, R., Dillon, A., Armstrong, B. K., & O’Connell, D. L. (2016). Lung

cancer treatment and mortality for Aboriginal people in New South Wales, Australia: results from a population-based record linkage study and medical record audit. BMC cancer, 16(1), 289.

Gould, G. S., Watt, K., West, R., Cadet-James, Y., & Clough, A. R. (2016). Can smoking

initiation contexts predict how adult Aboriginal smokers assess their smoking risks? A cross-sectional study using the ‘Smoking Risk Assessment Target’. BMJ open, 6(7), e010722.

Gray, A., & Tesfaghiorghis, H. (2018). Social indicators of the Aboriginal population of Australia.

Hodyl, N. A., Grzeskowiak, L. E., Stark, M. J., Scheil, W., & Clifton, V. L. (2014). The impact

of Aboriginal status, cigarette smoking and smoking cessation on perinatal outcomes in South Australia. Med J Aust, 201(5), 274-278.

Hyde, Z., Smith, K., Flicker, L., Atkinson, D., Almeida, O. P., Lautenschlager, N. T., ... &

LoGiudice, D. (2018). Mortality in a cohort of remote-living Aboriginal Australians and associated factors. PloS one, 13(4), e0195030.

Jun, A. (2017). Smoking Problems in Japan. In Social Problems (pp. 81-87). Routledge.

Nursing and Midwifery Board of Australia - Registered nurse standards for practice. (2018).

Purdie, N., Dudgeon, P., & Walker, R. (2010). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.

Rodríguez-Planas, N., & Sanz-de-Galdeano, A. (2016). Social Norms and Teenage Smoking:The Dark Side of Gender Equality.

Thomas, D. P., Lusis, N., Van der Sterren, A. E., & Borland, R. (2018). Electronic Cigarette Use

and Understanding Among a National Sample of Australian Aboriginal and Torres Strait Islander Smokers. Nicotine & Tobacco Research.

Wright, A. (2018). Survey of Aboriginal smokers' and ex?smokers’ knowledge, attitudes and

behaviours in Central Australia 2016–2017. Australian Journal of Rural Health, 26(4), 251-257.

Wright, A., Lovett, R., Roe, Y., & Richardson, A. (2018). Enhancing national data to align with

policy objectives: Aboriginal and Torres Strait Islander smoking prevalence at finer geographic levels. Australian Health Review, 42(3), 348-355.