Can we measure daily tobacco consumption in remote Indigenous communities? Comparing self-reported tobacco consumption with community-level estimates in an Arnhem Land study

Introduction and Aims. In remote Indigenous Australian communities measuring individual tobacco use can be confounded by cultural expectations, including sharing. We compared self-reported tobacco consumption with community-level estimates in Arnhem Land (Northern Territory). Design and Methods. In a cross-sectional survey in three communities (population 2319 Indigenous residents, aged >= 16 years), 400 Indigenous residents were interviewed (206 men, 194 women). Eight community stores provided information about tobacco sold during the survey. To gauge the impact of 255 non-Indigenous residents on tobacco turnover, 10 were interviewed (five men, five women). Breath carbon monoxide levels confirmed self-reported smoking. Self-reported number of cigarettes smoked per day was compared with daily tobacco consumption per user estimated using amounts of tobacco sold during 12 months before the survey (2007-2008). 'Lighter smokers' (< 10 cigarettes per day) and 'heavier smokers' (>= 10 cigarettes per day) in men and women were compared. Results. Of 400 Indigenous study participants, 305 (76%) used tobacco; four chewed tobacco. Of 301 Indigenous smokers, 177 (58%) provided self-reported consumption information; a median of 11-11.5 cigarettes per day in men and 5.5-10 cigarettes per day in women. Men were three times (odds ratio = 2.9) more likely to be 'heavier smokers'. Store turnover data indicated that Indigenous tobacco users consumed the equivalent of 9.2-13.1 cigarettes per day; very similar to self-reported levels. Sixty per cent (= 6/10) of non-Indigenous residents interviewed were smokers, but with little impact on tobacco turnover overall (2-6%). Discussion and Conclusions. Smoking levels reported by Indigenous Australians in this study, when sharing tobacco was considered, closely reflected quantities of tobacco sold in community stores. [Clough AR, MacLaren DJ, Robertson JA, Ivers RG, Conigrave KM. Can we measure daily tobacco consumption in remote Indigenous communities? Comparing self-reported tobacco consumption with community-level estimates in an Arnhem Land study. Drug Alcohol Rev 2010].