Elsevier

Women and Birth

Volume 26, Issue 4, December 2013, Pages 246-253
Women and Birth

“Nobody smokes in the house if there's a new baby in it”: Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia

https://doi.org/10.1016/j.wombi.2013.08.006Get rights and content

Abstract

Background

Smoking prevalence in Aboriginal and Torres Strait Islander pregnant women is quadruple that of non-Indigenous counterparts, impacting on the health of babies and children.

Aims

To explore attitudes and experiences related to prenatal tobacco smoking by Aboriginal women and household smoking, and to provide recommendations for culturally appropriate interventions.

Methods

We conducted five focus groups with clients and family members of a regional NSW Aboriginal maternity service (n = 18). Committees, including Aboriginal representatives, oversaw the study. We analysed transcripts with the constant comparative method and developed key categories.

Findings

Categories included: social and family influences, knowing and experiencing the health effects of smoking, responses to health messages, cravings and stress, giving up and cutting down, managing smoke-free homes and cars, and community recommendations. Smoking in pregnancy and passive smoking were acknowledged as harmful for babies and children. Anti-tobacco messages and cessation advice appeared more salient when concordant with women's lived experience. Reduced cigarette consumption was reported in pregnancy. Despite smoking in the home, families were engaged in the management of environmental tobacco smoke to reduce harm to babies and children. Abstinence was difficult to initiate or maintain with the widespread use of tobacco in the social and family realm.

Conclusion

Anti-tobacco messages and interventions should relate to Aboriginal women's experiences, improve understanding of the quitting process, support efficacy, and capitalise on the positive changes occurring in smoke-free home management. Focus group participants recommended individual, group and family approaches, and access to cessation services and nicotine replacement therapy for Aboriginal pregnant women who smoke.

Introduction

In Australia the prevalence of smoking in pregnant Aboriginal and Torres Strait Islander women is 49.3% compared with 12.1% for their non-Indigenous counterparts.1 Prenatal and perinatal smoking perpetuates disadvantage2 by being associated with: miscarriage, stillbirth, low birth weight and Sudden Unexpected Death in Infancy (SUDI), hearing and cognitive-behavioural problems in childhood,2 early smoking initiation,3 and inter-generational chronic diseases.4

Antecedents to smoking by Aboriginal and Torres Strait Islanders include the historical use of tobacco,5 colonisation and the impact of Government policies,5, 6 racism,7 socioeconomic inequities,6 the ‘stolen generation’8 and the scarcity of culturally appropriate services.6 Smoking in pregnant Aboriginal and Torres Strait Islander women is influenced by multiple factors such as sociocultural norms, family influences and stressors, limited knowledge of harms, anti-tobacco messages lacking relevance, and unfamiliarity about and access to cessation methods including nicotine replacement therapy (NRT).9 Despite these difficulties, pregnant Aboriginal and Torres Strait Islander smokers acknowledge their ‘protector role’ for the foetus.9, 10

Smoking cessation for pregnant Aboriginal and Torres Strait Islander women is a priority,11, 12 yet evidence about effective interventions is limited for pregnant Indigenous smokers in Australia,10, 11, 13, 14 and internationally.11, 12 Greater insight into the experiences of pregnant women who smoke is needed12 to develop salient health messages,9 culturally-relevant interventions and targeted support.11, 14 There is also a need to address gaps in knowledge related to Aboriginal and Torres Strait Islander women who smoke such as the use of NRT, responses to anti-tobacco mass media and the management of smoke-free homes.9

This study explored the responses of Aboriginal women and family members to issues about smoking in pregnancy and household smoking. The study sought to inform the development of a local cessation program for pregnant Aboriginal women using the views of the women and men involved in the study.

We use the term Aboriginal to refer to the local community and participants as the first peoples of NSW, and Aboriginal and/or Torres Strait Islander peoples when referring to wider Australian research.

Section snippets

Methods

We used focus groups as a way of understanding community perspectives and dialogue.15 Topics for discussion were selected from the literature on Aboriginal and Torres Strait Islanders who smoke when pregnant.9 The importance of family and partners to smoking guided sampling.16 A steering committee including Aboriginal stakeholders oversaw the study. A maternal subcommittee, including Aboriginal members and midwives, assisted in the study design, interview guide, and recruitment process, and

Results

Categories related to tobacco smoking in pregnancy included: social and family influences, knowing and experiencing the health effects of smoking, responses to health messages, craving and stress, giving up and cutting down, managing smoke-free homes and cars and community recommendations. Each researcher-defined theme is allocated a quote as subtitle.[Codes:FG=FocusGroupandnumber;M/F=maleorfemale;P=participant]

Discussion

This qualitative study explored Aboriginal people's attitudes to and experiences of smoking during pregnancy and household smoking at one Aboriginal maternity service in Australia. Our findings revealed multiple perspectives through interlinking factors that influenced maternal smoking. These factors included: social and family influences, lack of support for quitting, lack of relevance of anti-tobacco and educational messages to participants’ lived experience, protective parental attitudes to

Implications for practice and policy

These findings have implications for the appropriate development of tobacco control strategies at three levels: media messages, behavioural support and pharmacological treatment.

The static rates for smoking in Aboriginal and Torres Strait Islander pregnant women suggest that prevailing anti-tobacco messages may have been ineffective. During this focus group study an Indigenous-targeted National Tobacco Campaign was released,42 and a recent campaign targets smoking by pregnant Aboriginal and

Conclusion

This work builds on knowledge from a previous meta-ethnography of studies on smoking by Aboriginal and/or Torres Strait Islander women9 by bringing greater attention to issues of household smoking, NRT and views about susceptibility to tobacco harms. Anti-tobacco messages and interventions should relate to Aboriginal women's experiences, improve understanding of the quitting process, support efficacy, and capitalise on the positive changes occurring in smoke-free home management.

Declaration of interests

AM receives a personal income from Cancer Research UK via University College London. He has received travel funding, honorariums and consultancy payments from manufacturers of smoking cessation products (Pfizer Ltd, Novartis UK and GSK Consumer Healthcare Ltd). He also receives payment for providing training to smoking cessation specialists; receives royalties from books on smoking cessation and has a share in a patent of a nicotine delivery device.

Acknowledgements

The Australian Government Department of Health and Ageing Indigenous Tobacco Control Initiative funded this work. GG is in receipt of a post-graduate scholarship for Indigenous health research from National Health and Medical Research Council (Australia) and National Heart Foundation (Australia) APP1039759.

For their generous involvement in this study we would like to acknowledge the Aboriginal community and Elders, staff and clients from the Aboriginal Maternal and Infant Health Service, Coffs

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