“I have never experienced any problem with my health. So far, it hasn’t been harmful”: older Greek-Australian smokers’ views on smoking: a qualitative study

Mohammadnezhad et al. BMC Public Health I have never experienced any problem with my health. So far, it hasn't been harmful: older Greek-Australian smokers' views on smoking: a qualitative study Masoud Mohammadnezhad 0 1 George Tsourtos 1 Carlene Wilson 2 4 Julie Ratcliffe 3 Paul Ward 1 0 Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences , Tehran , Iran 1 Discipline of Public Health, Flinders University , GPO Box 2100, Adelaide, South Australia 5001 , Australia 2 Flinders Centre for Innovation in Cancer, Flinders University , GPO Box 2100, Adelaide 5001, South Australia , Australia 3 Flinders Health Economics Group, School of Medicine, Flinders University , GPO Box 2100, Adelaide 5001, South Australia , Australia 4 Cancer Council South Australia , Eastwood, South Australia , Australia Background: Smoking tobacco products is one of the largest preventable health risk factors for older people. Greek-Australians have the highest prevalence of cigarette use in Australia for older people, but there is a lack of knowledge about Greek-Australian's perspectives on smoking cessation. The purpose of this exploratory, qualitative study was to progress the knowledge base in this area. Methods: A qualitative study was designed to gather information on participants' perspectives about, and understanding of, their reasons for smoking and their attitudes to quitting. A snowball sampling technique was used to identify twenty Greek-Australian current smokers, aged 50 years. Semi-structured, face-to-face interviews were conducted with the assistance of a Greek translator. The audio-taped interviews were transcribed and then qualitative content analysis was used to categorise responses to the questions. Results: Participants' perspectives on three broad topics were identified in the interviews: perceived benefits of smoking, perceptions of smoking and its effect on health, and barriers to cessation. Smoking behaviour was described as contributing to tiredness, and stress, and yet also was also a source of enjoyment. Level of knowledge about smoking-related diseases and the risks of smoking was very low. The number of cigarettes smoked each day, type of smoking (i.e. pipe rather than cigarettes), and previous family history of smoking were identified as indicators that limited harm flows from smoking. Most participants had a positive attitude towards smoking and described their own life experience and cultural norms as supporting smoking acceptability. Low confidence in quitting was linked to advanced age. Conclusion: Smoking among older Greek-Australian smokers has been associated with a number of influences and these need to be addressed in smoking cessation efforts targeted at this group. Promoting knowledge about the health impacts of smoking, changing attitudes towards smoking, and ultimately, decreasing tobacco consumption are critical to the maintenance of health among older Greek Australians. Cultural and experiential influences may increase the difficulty associated with changing these outcomes, but may also serve as a framework from which to develop and implement an educational intervention tailored for older Greek-Australians. Greek-Australian smokers; Older people; Qualitative study; Knowledge; Attitude - Background Tobacco smoking is a major preventable cause of disease and premature death for older people [1]. In Australia, in 2010, the prevalence of smoking was reported to be 21.4 percent among people aged 50 to 59 years, 15.4 percent among people aged 60 to 69, and 7.8 percent of those older than 70 years were smokers [2]. The harmful effects of smoking are particularly serious for older people [3], and the mortality rate among older people is double that of non-smokers of similar ages [4]. In older people, smoking is a major contributory factor to a range of diseases including heart disease, stroke, respiratory disease and cancer [5]. Among older smokers, the benefits of quitting in terms of heart disease and stroke are almost immediate, and there is a rapid decrease in rates of mortality [6]. Smoking consumption in older smokers has a number of characteristics that need to be taken into account when designing an intervention to reduce or eliminate smoking in this group. These characteristics include; smoking history, extent of dependence on nicotine [7], the number of previous unsuccessful attempts to quit [8], and smoker doubts about the benefits of cessation. Older smokers may not accept that they are at risk of disease [9,10]. In Australia, different levels of smoking consumption have been reported among different ethnic groups. One study found that 42% of Indigenous Australians aged between 15 to 24 years smoke [11], compared to only 29.7% of Australians with Arabic backgrounds [12]. Greek-born Australians represent one of the largest ethnic communities in Australia. In the 2001 it was estimated that 2.8 per cent of the overseas-born population were Greek and this group constituted 0.6 percent of the total Australian population [13]. Smoking rates for some non-English speaking Background (NESB) groups, including Greek-Australians remains high, even though the prevalence of smoking in Australia in general has declined over the past two decades. Previous studies have highlighted a higher prevalence of smoking among Greek-Australians compared to other ethnic groups. In 1998, a household survey in the Marrickville Local Government Area (LGA) revealed smoking rates among males Greeks were significantly higher than for the general population (43% and 23% respectively). Other studies have shown similar findings in smoking prevalence among Greek-born males [14]. The smoking rate among elderly Greek-Australians is also higher than that of the average elderly Australian; it is estimated at 18.4% for Greek-born Australians aged 70 or older in comparison with 12% among the general Australian population in the same age group of [15]. Health-related knowledge can be an important factor that contributes to disparate views on the causes of smoking-related disease, such as cancer [16]. The results of previous studies among older smokers show that they have different levels of knowledge of, and varying perceptions about, the harms of smoking and the benefits of smoking cessation. For instance, Kerr et al., (2011) utilising interviews with 20 Scottish smokers and exsmokers aged 60 and over, found that the majority of current smokers were aware of the harmful health effects of smoking, although some of them were not fully aware of the most serious health dangers. Some of them had tried quitting and they indicated that health-related factors provided the motivation to quit [17]. Other influences on individual decision-making about quitting include community norms about the behaviour. Medb et al., (2011) reported that the attitude of elderly smokers to quitting and not starting again, was highly dependent upon the attit (...truncated)