An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial

Abstract

Objective: To determine the effectiveness of an intensive quit‐smoking intervention on smoking rates at 36 weeks’ gestation among pregnant Aboriginal and Torres Strait Islander women. Design: Randomised controlled trial. Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community‐controlled health services between June 2005 and December 2009. Intervention: A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence‐based communication skills and engaging the woman's partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control (“usual care”) group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits. Main outcome measure: Self‐reported smoking status (validated with a urine cotinine measurement) between 36 weeks’ gestation and delivery. Results: Participants in the intervention group (n = 148) and usual care group (n = 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86–1.08]; P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis. Conclusion: An intensive quit‐smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12609000929202.

A Pragmatic Guide for Smoking Cessation Counselling and the Initiation of Nicotine Replacement Therapy for Pregnant Aboriginal and Torres Strait Islander Smokers

“…Comprehensive and often intensive interventions are recommended for pregnant Aboriginal and Torres Strait Islander women (Lumley et al, 2009) but so far evidence to guide successful interventions by health practitioners and policy makers is lacking (Eades et al, 2012;Lumley, 2009). …”

Stages of Change, Smoking Behaviour and Readiness to Quit in a Large Sample of Indigenous Australians Living in Eight Remote North Queensland Communities

“…Despite these high rates of tobacco smoking in Indigenous individuals, there are few smoking cessation interventions conducted in this population, with limited evidence of efficacy [4,16,17,18,19,20]. In the context of tobacco control interventions, the Transtheoretical Model proposed by Prochaska and DiClemente and colleagues [21,22] lends itself to the examination of smoking behaviour change with a view to developing “stage matched interventions”.…”

Supporting Pregnant Aboriginal and Torres Strait Islander Women to Quit Smoking: Views of Antenatal Care Providers and Pregnant Indigenous Women

“…Disparities in smoking rates between Indigenous and non-Indigenous pregnant women are also marked in the United States, Canada and New Zealand [2–4]. While interventions to reduce antenatal smoking are known to be effective in non-Indigenous populations [5], to date effective interventions for pregnant Indigenous women have not been identified [6–8]. …”