Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026
Effectiveness and implementation of an indigenous-led mailed smoking cessation intervention for aboriginal and torres strait islander people: outcomes of a hybrid type 1 trial.
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Kennedy Michelle, Booth Kade, Bryant Jamie, Collis Felicity, Roberts-Barker Kayden, Mills Zabowie, Bonevski Billie, Maddox Raglan, Chamberlain Catherine, Segan Catherine, Doran Chris, Leigh Lucy
Аннотация
INTRODUCTION: Aboriginal and Torres Strait Islander people report disproportionately high rates of tobacco use, driven by the tobacco industry and sustained through coloniality. A gap remains regarding the effectiveness of culturally tailored, community-led cessation strategies.
METHODS: A pre-post hybrid type 1 effectiveness-implementation trial was conducted across NSW, ACT, and Victoria, Australia. Eligible participants identified as Aboriginal and/or Torres Strait Islander, current daily smokers aged ≥16 years and willing to quit in the next 30 days. Participants received the Quit Pack intervention, consisting of mailed cessation resources, free combination nicotine replacement therapy (NRT), and behavioral support. Surveys were completed at baseline, 3 months, and 6 months. Data were collected between October 2023 and February 2025. Intention-to-treat (ITT) and complete case (CC) analyzes were conducted.
RESULTS: A total of 722 participants were included. At 6-months follow-up, 16% reported 7-day PPA in the ITT analysis (39% CC). At 3-months follow-up, 23% reported 7-day PPA (ITT; 44% CC). At 6-months, continuous abstinence was reported by 11% of participants (30% CC), and 30% of participants reported making a quit attempt lasting at least 24 hours (97% CC). Almost all participants (97.5%) requested NRT at baseline, and 96% reported using NRT at 3 months. Intervention acceptability was high; 88% rated receiving free NRT and having it mailed home as very important.
CONCLUSIONS: This Indigenous-led cessation trial, the largest conducted in Australia to date, demonstrates the acceptability and potential effectiveness of culturally responsive mailed cessation support incorporating combination NRT. Findings support national expansion of the intervention.
IMPLICATIONS: Urgent investment in cessation supports are required to address the significant burden of disease caused by tobacco on the health of Aboriginal and Torres Strait Islander people. Quit Pack shows promise as both an acceptable and effective smoking cessation intervention for Aboriginal and Torres Strait Islander people in New South Wales, Victoria and the Australian Capital Territory. The program has potential to scale up country-wide with appropriate funding and partnerships with diverse Aboriginal and Torres Strait Islander communities.
METHODS: A pre-post hybrid type 1 effectiveness-implementation trial was conducted across NSW, ACT, and Victoria, Australia. Eligible participants identified as Aboriginal and/or Torres Strait Islander, current daily smokers aged ≥16 years and willing to quit in the next 30 days. Participants received the Quit Pack intervention, consisting of mailed cessation resources, free combination nicotine replacement therapy (NRT), and behavioral support. Surveys were completed at baseline, 3 months, and 6 months. Data were collected between October 2023 and February 2025. Intention-to-treat (ITT) and complete case (CC) analyzes were conducted.
RESULTS: A total of 722 participants were included. At 6-months follow-up, 16% reported 7-day PPA in the ITT analysis (39% CC). At 3-months follow-up, 23% reported 7-day PPA (ITT; 44% CC). At 6-months, continuous abstinence was reported by 11% of participants (30% CC), and 30% of participants reported making a quit attempt lasting at least 24 hours (97% CC). Almost all participants (97.5%) requested NRT at baseline, and 96% reported using NRT at 3 months. Intervention acceptability was high; 88% rated receiving free NRT and having it mailed home as very important.
CONCLUSIONS: This Indigenous-led cessation trial, the largest conducted in Australia to date, demonstrates the acceptability and potential effectiveness of culturally responsive mailed cessation support incorporating combination NRT. Findings support national expansion of the intervention.
IMPLICATIONS: Urgent investment in cessation supports are required to address the significant burden of disease caused by tobacco on the health of Aboriginal and Torres Strait Islander people. Quit Pack shows promise as both an acceptable and effective smoking cessation intervention for Aboriginal and Torres Strait Islander people in New South Wales, Victoria and the Australian Capital Territory. The program has potential to scale up country-wide with appropriate funding and partnerships with diverse Aboriginal and Torres Strait Islander communities.