Factors Associated with Smoke-Free Pregnancy among Aboriginal and Torres Strait Women and Their Experience of Quitting Smoking in Pregnancy: A Mixed Method Cross-Sectional Study

Abstract

Smoke-free pregnancies have long-term health benefits for mothers and babies. This paper quantitatively examines factors associated with smoke-free pregnancies among Aboriginal and Torres Strait Islander women (hereafter Aboriginal women) and qualitatively explores their smoking cessation (SC) experiences during pregnancy. An Aboriginal-led online cross-sectional study on SC was conducted with Aboriginal women and in partnership with Aboriginal communities, between July and October 2020. The present analysis includes participants who made a pregnancy-related quit attempt (N = 103). Chi-squared tests, logistic regression models, and thematic analysis of free-form text responses were performed. The adjusted odds of having smoke-free pregnancies were 4.54 times higher among participants who used Aboriginal Health Services (AHS) (AOR = 4.54, p-value 0.018). Participants living in urban settings had 67% lower odds of having smoke-free pregnancies compared to their regional/remote counterparts (AOR = 0.33, p-value 0.020). Qualitative data revealed strong motivations to reduce tobacco-related harms to the fetus and variability in quitting experiences at different stages of and across pregnancies. Smoking cessation care (SCC) can support Aboriginal women meaningfully if their quitting experiences are considered in SCC development and implementation. Consistent funding for AHS-led SCC is needed to garner health benefits for Aboriginal peoples. More research into urban versus regional/remote differences in maternal SC is recommended.

“It Needs a Full-Time Dedicated Person to Do This Job in Our Local Communities with Our Aboriginal Health Services”—Aboriginal and Torres Strait Islander Health Workers and Practitioners Perspectives on Supporting Smoking Cessation during Pregnancy

“…There is a critical need to support Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. The high prevalence rates, despite a high motivation to quit smoking among Aboriginal and Torres Strait Islander pregnant women, suggests more could be conducted to increase the rate of smoke-free pregnancies [12]. This is consistent with the draft National Tobacco Strategy [37] and the WHO Framework Convention on Tobacco Control [38], which report that providing comprehensive tobacco control approaches, including high-quality, culturally safe smoking cessation care, can support significant reductions in smoking prevalence.…”

“…Aboriginal and Torres Strait Islander women who smoke are likely to attempt to quit smoking during pregnancy [11,12,17]. While two-thirds (66.4%) of AHW/AHP believed they were best placed to provide smoking cessation support for Aboriginal and Torres Strait Islander people, less than half (48.4%) reported this same role for pregnant women.…”

“…While the past decade has reported improvements in reduced smoking prevalence during pregnancy, in 2020, it was reported that 43% of Aboriginal and Torres Strait Islander women smoked at some stage during their pregnancy [10]. While data often only reports an overall prevalence, recent research led by Kennedy et al found that Aboriginal and Torres Strait Islander women wanted to quit [11] and that 93% are changing their smoking behaviours, including reducing cigarette consumption during pregnancy [12].…”

Maternal and neonatal health outcomes for First Nations Australian women and children: A retrospective cohort study in a Western Sydney metropolitan tertiary referral centre

“…1 We did not collect smoking cessation rates in pregnancy, however national data shows that First Nations mothers are more likely to attempt to quit smoking but less likely to succeed, and smoke-free pregnancies are 4.5 times higher amongst women accessing culturally specific health services. 19 This study showed significantly lower birth weight associated with smoking and drug use, highlighting a need for prioritisation of Frist-Nations led approaches to smoking and substance use cessation within local antenatal care and improved preconception support for prepregnancy smoking cessation. 20 Higher rates of maternal smoking, alcohol and drug use, and psychosocial vulnerabilities in children where either or both parents are First Nations indicate that culturally specific support services may need to be offered to both parents during the antenatal period.…”

“…National rates of smoking in pregnancy are 42% for First Nations mothers and 7% for non‐First Nations mothers 1 . We did not collect smoking cessation rates in pregnancy, however national data shows that First Nations mothers are more likely to attempt to quit smoking but less likely to succeed, and smoke‐free pregnancies are 4.5 times higher amongst women accessing culturally specific health services 19 . This study showed significantly lower birth weight associated with smoking and drug use, highlighting a need for prioritisation of Frist‐Nations led approaches to smoking and substance use cessation within local antenatal care and improved preconception support for pre‐pregnancy smoking cessation 20 .…”