"It's almost expected": rural Australian Aboriginal women's reflections on smoking initiation and maintenance: a qualitative study

Abstract

BackgroundDespite declining smoking rates among the general Australian population, rates among Indigenous Australians remain high, with 47% of the Indigenous population reporting daily smoking - twice that of other Australians. Among women, smoking rates are highest in younger age groups, with more than half of Aboriginal women smoking during pregnancy. A lack of research focused on understanding the social context of smoking by Aboriginal women in rural Australia limits our ability to reduce these rates. This study aimed to explore the factors contributing to smoking initiation among rural Aboriginal women and girls and the social context within which smoking behaviour occurs.MethodsWe conducted three focus groups with 14 Aboriginal women and service providers and 22 individual interviews with Aboriginal women from four rural communities to explore their perceptions of the factors contributing to smoking initiation among Aboriginal girls.ResultsFour inter-related factors were considered important to understanding the social context in which girls start smoking: colonisation and the introduction of tobacco; normalization of smoking within separate Aboriginal social networks; disadvantage and stressful lives; and the importance of maintaining relationships within extended family and community networks. Within this context, young girls use smoking to attain status and as a way of asserting Aboriginal identity and group membership, a way of belonging, not of rebelling. Family and social structures were seen as providing strong support, but limited the capacity of parents to influence children not to smoke. Marginalization was perceived to contribute to limited aspirations and opportunities, leading to pleasure-seeking in the present rather than having goals for the future.ConclusionsThe results support the importance of addressing contextual factors in any strategies aimed at preventing smoking initiation or supporting cessation among Aboriginal girls and women. It is critical to acknowledge Aboriginal identity and culture as a source of empowerment; and to recognise the role of persistent marginalization in contributing to the high prevalence and initiation of smoking.

Smoking related attitudes, motives, and behaviors of male secondary school students in an urban setting of China

“…Therefore, the possibility of smoking increased with the number of friends who smoke, suggesting that the peers easily influence the behavior of students. Many studies have reported that peer pressure and fathers who smoke are important factors which influence the smoking of youth (Passey et al 2011). Numerous examples of smokers in the environment, especially in the companion of a role model who smoke will increase the odds of the smoking behavior of a teenager (Hawkins et al 1992; Keefe 1994).…”

The maternal and neonatal outcomes for an urban Indigenous population compared with their non-Indigenous counterparts and a trend analysis over four triennia

“…Although smoking during pregnancy is associated with a higher prevalence of preterm birth (approximately 40%), and almost 100% higher proportion of low birth weight infants, national data [36] suggests that rates of preterm births, LBW infants, and perinatal deaths were higher for infants born to Indigenous mothers regardless of pregnancy-related smoking status. Strategies to date to address smoking amongst pregnancy in Indigenous women have been relatively unsuccessful, perhaps not least because research suggests that social context is an important factor with smoking providing a sense of belonging and identity, and group membership [37]. Smoking cessation interventions in pregnancy, however, are known to make a difference to low birth weight and preterm birth in the general population of childbearing women [38] with a recent survey of Aboriginal women reporting 21% quit in pregnancy with 46% reducing their intake.…”

Tobacco Cessation Interventions for Underserved Women

“…A study in Denmark found that smokers who had reported a previous quit attempt and who were of low socioeconomic status were more likely to report relapse due to depression, tension or nervousness than participants reporting higher socioeconomic status (Pisinger & Godtfredsen, 2007). Several studies with Aboriginal girls and women and young women indicate that women often take up and continue to smoke to cope with stress (Amos & Bostock, 2007;de Finney et al, 2013;Passey, Gale, & Sanson-Fisher, 2011). Intervention approaches need to recognize the link between smoking and stress, particularly for underserved groups of women, and consider how best to help women address and manage these stressors while supporting reduction and cessation efforts.…”