Getting over the shock: taking action on Indigenous maternal smoking

Abstract

Abstract.Smoking rates are slow to decline among pregnant Indigenous women. One in two pregnant Indigenous Australian women is a tobacco smoker compared with one in eight in the non-Indigenous population. The National Close the Gap strategy ambitiously aims to reduce Indigenous smoking prevalence to half by 2018, but this goal is unlikely to be achieved. Evidence is growing to better inform targeted strategies for Indigenous pregnant women based on national and international studies. It is proposed to be an appropriate time to refine translational approaches for anti-tobacco messages and cessation support in this population, rather than waiting for further empirical research before making these essential changes. Systemic barriers to Indigenous pregnant women receiving equitable primary health care have been identified, are remediable, and urgently require addressing. These barriers include: (1) lack of subsidised access to suitable oral forms of nicotine replacement therapy; (2) lack of clinician training in the complex area of management of maternal Indigenous smoking; and (3) lack of targeted health promotion programs addressing the psychosocial challenges that Indigenous women face. In the interim, translational strategies to target tobacco control and cessation in pregnant Indigenous women need to be based on current evidence.

Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

“…This study described the developmental and translational research to identify key components for a culturally competent smoking cessation implementation intervention aimed at educating and training health providers and providing resources to support Indigenous women to quit smoking and support making a smoke-free home. The BCW has been used previously to analyse and recommend targeted strategies [ 4 , 35 ]. We provided a more detailed analysis of the theoretical components for a smoking cessation implementation intervention for pregnant Indigenous Australian women, than hitherto published, aimed principally at changing health provider behaviour.…”

“…This study was based on a growing body of evidence including systematic reviews by Okoli et al about the provision of smoking cessation care by health providers [ 9 ] and by Baxter et al about the uptake of smoking cessation care by pregnant women [ 26 , 32 ], which demonstrated gaps in delivery of elements of SCC from the provider and patient viewpoints, and a systematic review by Gould et al about Aboriginal women’s views of smoking during pregnancy [ 33 ]. Several narrative explorations of the influences on smoking among Indigenous women including two analyses using the BCW [ 2 , 4 , 34 , 35 ], and empirical studies from both health providers’ and Indigenous women’s views about knowledge, attitudes and practices, were considered [ 36 – 40 ].…”

Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review

“…25 Qualitative investigations to date suggest that antitobacco messages need to be relevant and be tailored to Indigenous women's experiences, with a focus on quitting processes and support efficacy (including individual, group, and family involvement) and should capitalize on the positive changes occurring in smoke-free homes. 24,132 Several systemic barriers have been highlighted in Australia: these include a lack of subsidized oral forms of NRT (which are recommended as the safest option in pregnancy), lack of knowledge, confidence and skill in health providers, and caring for pregnant Indigenous women. 119,133 There is a lack of specificity of guidelines to the Indigenous context in pregnancy, although Gould et al recently published a pragmatic guide, based on an ABCD model (Ask/Assess; Brief Advice; Cessation support; Discuss the psychosocial context.…”

Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women

“…Formative research ensures the development of targeted, culturally appropriate, health messages that work [ 17 , 18 ]. In the past few years, research done specifically with Aboriginal pregnant women has shed light on some of the myths and beliefs about smoking during pregnancy that are a barrier to quitting [ 19 , 20 , 21 , 22 ]. Additionally, in developing a suitable intervention, the challenge of designing appropriate anti-tobacco messages that account for the diversity of Aboriginal People has been outlined [ 19 ].…”