Skip to main content

01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Public Health 1/2016

Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review

BMC Public Health > Ausgabe 1/2016
Alexa Minichiello, Ayla R. F. Lefkowitz, Michelle Firestone, Janet K. Smylie, Robert Schwartz
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2645-x) contains supplementary material, which is available to authorized users.

Competing interests

No competing interests.

Authors’ contributions

JS, RS, MF, AL, and AM were involved in all stages of the project including design, screening, review and analysis. AM and AL conducted screening and data extraction. AM and AL drafted the manuscript. All authors contributed to and have approved the final manuscript.



All over the world, Indigenous populations have remarkably high rates of commercial tobacco use compared to non-Indigenous groups. The high rates of commercial tobacco use in Indigenous populations have led to a variety of health issues and lower life expectancy than the general population. The objectives of this systematic review were to investigate changes in the initiation, consumption and quit rates of commercial tobacco use as well as changes in knowledge, prevalence, community interest, and smoke-free environments in Indigenous populations. We also aimed to understand which interventions had broad reach, what the common elements that supported positive change were and how Aboriginal self-determination was reflected in program implementation.


We undertook a systematic review of peer-reviewed publications and grey literature selected from seven databases and 43 electronic sources. We included studies between 1994 and 2015 if they addressed an intervention (including provision of a health service or program, education or training programs) aimed to reduce the use of commercial tobacco use in Indigenous communities globally. Systematic cross-regional canvassing of informants in Canada and internationally with knowledge of Indigenous health and/or tobacco control provided further leads about commercial tobacco reduction interventions. We extracted data on program characteristics, study design and learnings including successes and challenges.


In the process of this review, we investigated 73 commercial tobacco control interventions in Indigenous communities globally. These interventions incorporated a myriad of activities to reduce, cease or protect Indigenous peoples from the harms of commercial tobacco use. Interventions were successful in producing positive changes in initiation, consumption and quit rates. Interventions also facilitated increases in the number of smoke-free environments, greater understandings of the harms of commercial tobacco use and a growing community interest in addressing the high rates of commercial tobacco use. Interventions were unable to produce any measured change in prevalence rates.


The extent of this research in Indigenous communities globally suggests a growing prioritization and readiness to address the high rates of commercial tobacco use through the use of both comprehensive and tailored interventions. A comprehensive approach that uses multiple activities, the centring of Aboriginal leadership, long term community investments, and the provision of culturally appropriate health materials and activities appear to have an important influence in producing desired change.
Additional file 1: Search Strategy. Example of the studies search strategy using the EMBASE database. (PDF 53 kb)
Additional file 3: Quality Assessment Tool. (PDF 71 kb)
Additional file 4: Title of data: Intervention Activity and Outcome Efficacy Data. Description of data: Summary comparison of intervention characteristics and efficacy data for the seven outcomes. (XLSX 18 kb)
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2016

BMC Public Health 1/2016 Zur Ausgabe