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Small SP, Maddigan J, Swab M, Jarvis K. Pregnant and postnatal women's experiences of interacting with health care providers about their tobacco smoking: a qualitative systematic review. JBI Evid Synth 2022:02174543-990000000-00111. [PMID: 36477572 DOI: 10.11124/jbies-22-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this review was twofold: (i) to comprehensively identify the best available evidence about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) concerning health care providers' interactions with them about their smoking, when such interactions occurred during contact for prenatal or postnatal health care in any health care setting; and (ii) to synthesize the research findings for recommendations to strengthen health care providers' interventions regarding smoking during pregnancy and smoking during the postnatal period. INTRODUCTION Maternal tobacco smoking during pregnancy and maternal tobacco smoking postnatally pose serious health risks for the woman, fetus, and offspring, whereas maternal smoking cessation has beneficial health effects. Given the importance of health care providers' interactions with pregnant and postnatal women for smoking cessation care, it is essential to understand women's experiences of such interactions. INCLUSION CRITERIA Studies considered for this review had qualitative research findings about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) in relation to health care providers' interactions with them about their smoking. METHODS The review was conducted using the JBI approach to qualitative systematic reviews. Published studies were sought through 6 academic databases (eg, CINAHL, MEDLINE). Unpublished studies were searched in 6 gray literature sources (eg, ProQuest Dissertations and Theses, Google Scholar). Reference lists of retrieved records were also searched. The searches occurred in October and November 2020; no country, language, or date limits were applied. Study selection involved title and abstract screening, full-text examination, and critical appraisal of all studies that met the inclusion criteria for the review. Study characteristics and research findings were extracted from the included studies. Study selection and extraction of findings were conducted by two reviewers independently; differences between reviewers were resolved through consensus. The research findings were categorized, and the categories were aggregated into a set of synthesized findings. The synthesized finding were assigned confidence scores. The categories and finalized synthesized findings were agreed upon by all reviewers. RESULTS The 57 included studies varied in qualitative research designs and in methodological quality (from mostly low to high). There were approximately 1092 eligible participants, and 250 credible and unequivocal research findings. The research findings yielded 14 categories and 6 synthesized findings with low to very low confidence scores. Some women who smoked tobacco during pregnancy and some women who smoked tobacco postnatally lacked supportive interactions by health care providers regarding their smoking; other women experienced supportive interactions by health care providers. Women were adversely impacted when health care providers' interactions lacked supportiveness, and were beneficially impacted when interactions were supportive. Women varied in openness to health care providers' interactions regarding their smoking, from not being receptive to being accepting, and some women wanted meaningful health care provider interactions. CONCLUSIONS Although confidence in the synthesized findings is low to very low, the evidence indicates that supportive health care provider interactions may facilitate positive smoking behavior change in pregnancy and postnatally. It is recommended that health care providers implement accepted clinical practice guidelines with women who smoke prenatally or postnatally, using an approach that is person-centered, emotionally supportive, engaging (eg, understanding), and non-authoritarian. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020178866.
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Affiliation(s)
- Sandra P Small
- Faculty of Nursing, Memorial University, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Joy Maddigan
- Faculty of Nursing, Memorial University, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Michelle Swab
- Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada.,Health Sciences Library, Memorial University, St. John's, NL, Canada
| | - Kimberly Jarvis
- Faculty of Nursing, Memorial University, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
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Allen L, Wodtke L, Hayward A, Read C, Cyr M, Cidro J. Pregnant and early parenting Indigenous women who use substances in Canada: A scoping review of health and social issues, supports, and strategies. J Ethn Subst Abuse 2022; 22:827-857. [PMID: 35238726 DOI: 10.1080/15332640.2022.2043799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study reviews and synthesizes the literature on Indigenous women who are pregnant/early parenting and using substances in Canada to understand the scope and state of knowledge to inform research with the Aboriginal Health and Wellness Centre of Winnipeg in Manitoba and the development of a pilot Indigenous doula program. A scoping review was performed searching ten relevant databases, including one for gray literature. We analyzed 56 articles/documents. Themes include: (1) cyclical repercussions of state removal of Indigenous children from their families; (2) compounding barriers and inequities; (3) prevalence and different types of substance use; and (4) intervention strategies. Recommendations for future research are identified and discussed.
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Affiliation(s)
| | | | | | - Chris Read
- McMaster University, Hamilton, Ontario, Canada
| | - Monica Cyr
- Aboriginal Health and Wellness Centre, Winnipeg, Manitoba, Canada
| | - Jaime Cidro
- University of Winnipeg, Winnipeg, Manitoba, Canada
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Rahman T, Baker AL, Gould GS, Palazzi K, Lambkin D, Kennedy M. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11240. [PMID: 34769756 PMCID: PMC8583423 DOI: 10.3390/ijerph182111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Tabassum Rahman
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Amanda L. Baker
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - David Lambkin
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia; (A.L.B.); (M.K.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia; (K.P.); (D.L.)
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Small SP, Porr C. Indigenous Women's Experiences of Smoking and Quitting Smoking in Pregnancy: A Phenomenological Study. Can J Nurs Res 2021; 54:144-155. [PMID: 34668420 DOI: 10.1177/08445621211044324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Maternal smoking during pregnancy (MSDP) is an important public health concern because of potential adverse health effects to the woman, fetus, and child after birth. Prevalence rates are high among groups with socioeconomic disadvantage, including Indigenous women. PURPOSE This study was conducted to understand experiences of MSDP for Indigenous women. METHODS The study was conducted using phenomenology. Data were collected through interviews with 15 pregnant and postnatal Indigenous women who had smoked during pregnancy. The data were analyzed for themes using phenomenological methods. RESULTS The women's narratives revealed four experiences: quitting smoking during pregnancy to protect the unborn baby from harm; quitting smoking during pregnancy because of personal adverse health effects; cutting down smoking during pregnancy and feeling remorse for not quitting; and keeping on smoking during pregnancy and not planning to try to quit. The women's experiences also indicated several impediments to quitting smoking. CONCLUSIONS There is need for health care policy to ensure adequate smoking cessation services and support for Indigenous women who smoke in pregnancy. Health care professionals should provide individualized interventions that take into account the challenges to quitting that pregnant women experience and that are in accordance with clinical practice guidelines for MSDP.
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Affiliation(s)
- Sandra P Small
- Faculty of Nursing, 7512Memorial University, St. John's, NL, Canada
| | - Caroline Porr
- Faculty of Nursing, 7512Memorial University, St. John's, NL, Canada
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Flemington T, La Hera-Fuentes G, Bovill M, Hart A, Bennett J, Ryan NM, Gould GS. Smoking Cessation Messages for Pregnant Aboriginal and Torres Strait Islander Women: A Rapid Review of Peer-Reviewed Literature and Assessment of Research Translation of Media Content. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179341. [PMID: 34501931 PMCID: PMC8430943 DOI: 10.3390/ijerph18179341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
This review summarized literature about knowledge, attitudes, and beliefs of Aboriginal and Torres Strait Islander women from Australia who smoke during pregnancy, then examined the extent that existing health promotion materials and media messages aligned with evidence on smoking cessation for pregnant Aboriginal and Torres Strait Islander women. Knowledge, attitudes, and beliefs of pregnant Aboriginal women who smoke tobacco were identified in the literature. Health promotion campaigns were retrieved from a grey literature search with keywords and social and professional networks. Key themes from peer-reviewed papers were compared against the content of health promotion campaigns using the Aboriginal Social and Emotional Wellbeing Model, the Behavior Change Wheel and thematic analysis. Eleven empirical studies and 17 campaigns were included. Empirical studies highlighted women sought holistic care that incorporated nicotine replacement therapy, engaged with their family and community and the potential for education about smoking cessation to empower a woman. Health promotion campaigns had a strong focus on ‘engagement with family and community’, ‘knowledge of risks of smoking,’ ‘giving up vs cutting down’ and ‘culture in language and arts’. There were similarities and variances in the key themes in the research evidence and promotion materials. Topics highly aligned included risks from smoking and quitting related issues.
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Affiliation(s)
- Tara Flemington
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW 2006, Australia;
| | - Gina La Hera-Fuentes
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.L.H.-F.); (M.B.); (A.H.); (J.B.); (N.M.R.)
| | - Michelle Bovill
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.L.H.-F.); (M.B.); (A.H.); (J.B.); (N.M.R.)
| | - Allison Hart
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.L.H.-F.); (M.B.); (A.H.); (J.B.); (N.M.R.)
| | - Jessica Bennett
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.L.H.-F.); (M.B.); (A.H.); (J.B.); (N.M.R.)
| | - Nicole M. Ryan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.L.H.-F.); (M.B.); (A.H.); (J.B.); (N.M.R.)
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2480, Australia
- Correspondence:
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The needs of women and their partners regarding professional smoking cessation support during pregnancy: A qualitative study. Women Birth 2021; 35:127-134. [PMID: 33781708 DOI: 10.1016/j.wombi.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the health risks of smoking, some women continue during pregnancy. Professional smoking cessation support has shown to be effective in increasing the proportion of pregnant women who quit smoking. However, few women actually make use of professional support. AIM To investigate the needs of women and their partners for professional smoking cessation support during pregnancy. METHODS Semi-structured interviews were held with pregnant women and women who recently gave birth who smoked or quit smoking during pregnancy, and their partners, living in the north of the Netherlands. Recruitment was done via Facebook, LinkedIn, food banks, baby stores and healthcare professionals. The interviews were recorded, transcribed and thematically analysed. RESULTS 28 interviews were conducted, 23 with pregnant women and women who recently gave birth, and five with partners of the women. The following themes were identified: 1) understanding women's needs, 2) responsibility without criticism, and 3) women and their social network. These themes reflect that women need support from an involved and understanding healthcare professional, who holds women responsible for smoking cessation but refrains from criticism. Women also prefer involvement of their social network in the professional support. CONCLUSION For tailored support, the Dutch guideline for professional smoking cessation support may need some adaptations. The adaptations and recommendations, e.g. to involve women and their partners in the development of guidelines, might also be valuable for other countries. Women prefer healthcare professionals to address smoking cessation in a neutral way and to respect their autonomy in the decision to stop smoking.
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Rahman T, Eftekhari P, Bovill M, Baker AL, Gould GS. Socioecological Mapping of Barriers and Enablers to Smoking Cessation in Indigenous Australian Women During Pregnancy and Postpartum: A Systematic Review. Nicotine Tob Res 2021; 23:888-899. [DOI: 10.1093/ntr/ntab003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
Abstract
Background
With a high prevalence of smoking during pregnancy and limited Indigenous-specific evidence for treatment, we used socioecological mapping to identify multilevel barriers and enablers to smoking cessation related to Indigenous Australian pregnant and postpartum women.
Methods
Nine electronic databases were searched. Original studies except interventions and trials, published in English, up to February 29, 2020 were included. Studies were appraised using the QualSyst tool. Evidence was narratively synthesized. The review protocol was registered with PROSPERO (CRD42019135543).
Results
A total of 15 studies (10 quantitative, 5 qualitative) were included, covering 1306 women, 3 partners/family members, 234 health professionals (HP), and 2755 patient records. Complex and overlapping barriers were identified at individual, family, community, societal, and system levels. Socioeconomic disadvantages, inequality, and pervasive racism as legacies of colonization, combined with personal, family, and community circumstances intensified individual experiences of stress, which may be heightened during pregnancy. Inadequate smoking cessation care (SCC), inconsistent antitobacco messages, and ineffectual HP interventions underscore a need for service enhancement and further evidence to develop culturally relevant messages. High motivation of pregnant women to quit, resilience, and supports available in the family and community are strengths that warrant attention in future interventions.
Conclusions
SCC without ameliorating the social disadvantages and the disparities in health determinants between Indigenous and non-Indigenous Australian women may limit the effectiveness of SCC. A comprehensive approach is required that includes policy changes for addressing external stressors the women experience, engagement of family and community, and better training of HP and provision of free pharmacotherapy.
Implications
To systematically address barriers to smoking cessation at multiple levels, initiatives to ameliorate social disadvantages and discrepancies in social determinants of health between Indigenous and non-Indigenous Australians are required to be taken in tandem with SCC. Initiatives may include making relevant policy changes and allocating more resources for education, employment, housing, and community development. Enhancement of knowledge, skills, and confidence of HP regarding the provision of high-quality SCC for Indigenous women and their families is warranted. Future interventions may build on high motivation, resilience, and strengths of individual women, and incorporate support strategies engaging family and community.
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Affiliation(s)
- Tabassum Rahman
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Level 4-West, 1/1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Parivash Eftekhari
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Level 4-West, 1/1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Level 4-West, 1/1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Level 4-West, 1/1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Gillian S Gould
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Level 4-West, 1/1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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Gould GS, Havard A, Lim LL, Kumar R. Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2034. [PMID: 32204415 PMCID: PMC7142582 DOI: 10.3390/ijerph17062034] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022]
Abstract
The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother's and child's health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.
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Affiliation(s)
- Gillian S. Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW Sydney, Sydney NSW 2052, Australia;
| | - Ling Li Lim
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
| | | | - Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
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Askew DA, Guy J, Lyall V, Egert S, Rogers L, Pokino LA, Manton-Williams P, Schluter PJ. A mixed methods exploratory study tackling smoking during pregnancy in an urban Aboriginal and Torres Strait Islander primary health care service. BMC Public Health 2019; 19:343. [PMID: 30909896 PMCID: PMC6434627 DOI: 10.1186/s12889-019-6660-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 11/06/2022] Open
Abstract
Background Pregnancy can be a time of joy and a time of significant stress. For many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress. Indigenous women smoke during pregnancy at higher rates than their non-Indigenous counterparts. Methods A mixed methods, exploratory study, undertaken in an urban, Indigenous primary health care service, tested the impact and acceptability of a smoking cessation intervention for women pregnant with an Indigenous baby, their significant other (SO), and their primary health care service. The intervention included case management, incentivised smoking cessation support and culturally-based art activities. Results Thirty-one pregnant women and 16 SOs participated. Nearly half attempted to quit at least once during the study, 36% (4/11) of pregnant women had quit at the 3 month assessment and two remained smoke free 1 month postpartum. Most participants self-reported a reduction in tobacco smoking. Exhaled CO confirmed this for SOs (mean reduction − 2.2 ppm/assessment wave, 95% CI: -4.0, − 0.4 ppm/assessment wave, p = 0.015) but not for pregnant women. Many participants experienced social and economic vulnerabilities, including housing and financial insecurity and physical safety concerns. Conclusions Tobacco smoking is normalised and socially sanctioned in Indigenous communities and smoking is frequently a response to the multitude of stressors and challenges that Indigenous people experience on a daily basis. Smoking cessation interventions for pregnant Indigenous women must be cognisant of the realities of their private lives where the smoking occurs, in addition to the impact of the broader societal context. Narrow definitions of success focussing only on smoking cessation ignore the psychological benefit of empowering women and facilitating positive changes in smoking behaviours. Our smoking cessation intervention supported pregnant women and their SOs to manage these stressors and challenges, thereby enabling them to develop a solid foundation from which they could address their smoking. A broad definition of success in this space is required: one that celebrates positive smoking behaviour changes in addition to cessation.
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Affiliation(s)
- Deborah A Askew
- School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8 Health Sciences Building, Building 16/910, Brisbane, QLD, 4029, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia.
| | - Jillian Guy
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Vivian Lyall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Lynne Rogers
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Peggy Manton-Williams
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Philip J Schluter
- School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8 Health Sciences Building, Building 16/910, Brisbane, QLD, 4029, Australia.,School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand
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