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Cameron E, Bryant J, Cashmore A, Passmore E, Oldmeadow C, Neill S, Milat A, Mitchell J, Gatt N, Macoun E, Ioannides SJ, Murray C. A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby. BMC Health Serv Res 2023; 23:532. [PMID: 37226175 DOI: 10.1186/s12913-023-09496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Quit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative. METHODS A mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact. RESULTS QFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96-1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients. CONCLUSION QFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.
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Affiliation(s)
- Emilie Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Aaron Cashmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Erin Passmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information and Statistical Support, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Sarah Neill
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Andrew Milat
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Jo Mitchell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Nicole Gatt
- Drug Health Services, Aboriginal Health Education Officer, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Edwina Macoun
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Sally J Ioannides
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Carolyn Murray
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
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Mersha AG, Maddox R, Maidment S, Booth K, Briscoe K, Hussein P, Longbottom H, Bar-Zeev Y, Kennedy M. "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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:28. [PMID: 36612349 PMCID: PMC9819709 DOI: 10.3390/ijerph20010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to Aboriginal and Torres Strait Islander pregnant women. METHOD A mixed-method study using quantitative and qualitative data was conducted among AHW/AHPs in 2021 across Australia. Descriptive and analytical statistics were used to characterise AHWs'/AHPs' attitudes towards SCC and to evaluate the factors associated with perceptions of who is best placed to provide SCC. RESULTS From the total AHW/AHP workforce, 21.2% (223) completed the survey. Less than half (48.4%) believed that AHW/AHP were best placed to provide SCC for pregnant women. The majority believed that group-based supports (82.5%) and cultural support programs (63.7%) were the best strategies to support Aboriginal and Torres Strait Islander pregnant women to quit smoking. CONCLUSION This study highlights the need to enhance SCC offered to Aboriginal and Torres Strait Islander pregnant women. A targeted workforce dedicated to smoking cessation should be resourced, including funding, standardised training, and ongoing SCC support tailored to Aboriginal and Torres Strait Islander pregnant women.
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Affiliation(s)
- Amanual Getnet Mersha
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW 2305, Australia
| | - Raglan Maddox
- National Centre for Epidemiology and Public Health, The Australian National University, Canberra, ACT 2601, Australia
| | - Sian Maidment
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kade Booth
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW 2305, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, Phillip, ACT 2606, Australia
| | - Paul Hussein
- Yerin Eleanor Duncan Aboriginal Health Centre, Wyong, NSW 2259, Australia
| | - Hayley Longbottom
- Waminda South Coast Women’s Health and Welfare Aboriginal Corporation, Nowra, NSW 2541, Australia
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, Israel
| | - Michelle Kennedy
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW 2305, Australia
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Protocol for iSISTAQUIT: Implementation phase of the supporting indigenous smokers to assist quitting project. PLoS One 2022; 17:e0274139. [DOI: 10.1371/journal.pone.0274139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction
About 44% of Aboriginal and/or Torres Strait Islander women smoke during pregnancy compared to 12% of their general population counterparts. Evidence-based quit smoking advice received from health care professionals (HCPs) can increase smoking cessation rates. However, HCPs lack culturally appropriate smoking cessation training, which is a major barrier to provision of smoking cessation care for this population.
Methods and analysis
iSISTAQUIT is a multicentre, single arm study aiming to implement and evaluate the evidence-based, culturally competent iSISTAQUIT smoking cessation training among health practitioners who provide support and assistance to pregnant, Aboriginal and Torres Strait Islander women in Australia. This project will implement the iSISTAQUIT intervention in Aboriginal Medical Services and Mainstream Health Services. The proposed sample size is 10 of each of these services (total N = 20), however if the demand is higher, we will aim to accommodate up to 30 services for the training. Participating sites and their HCPs will have the option to choose one of the two iSISTAQUIT packages available: a) Evaluation- research package b) Training package (with or without continued professional development points). Training will be provided via an online eLearning platform that includes videos, text, interactive elements and a treatment manual. A social media campaign will be conducted from December 2021 to September 2022 to raise brand and issue awareness about smoking cessation for Aboriginal and Torres Strait Islander women in pregnancy. This national campaign will consist of systematic advertising and promotion of iSISTAQUIT and video messages through various social media platforms.
Analysis
We will use the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to plan, evaluate and report the intervention impact of iSISTAQUIT. Effectiveness of social media campaign will be assessed via social media metrics, cross-sectional surveys, and interviews.
Discussion
This innovative research, using a multi-component intervention, aims to practically apply and integrate a highly translatable smoking cessation intervention in real-world primary care settings in Aboriginal Medical Services and Mainstream services. The research benefits Aboriginal women, babies and their family and community members through improved support for smoking cessation during pregnancy. The intervention is based on accepted Australian and international smoking cessation guidelines, developed and delivered in a culturally appropriate approach for Aboriginal communities.
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Kennedy M, Barrett E, Heris C, Mersha A, Chamberlain C, Hussein P, Longbottom H, Bacon S, Maddox R. Smoking and quitting characteristics of Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study. Med J Aust 2022; 217 Suppl 2:S6-S18. [PMID: 35842912 PMCID: PMC9545217 DOI: 10.5694/mja2.51630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe smoking characteristics, quitting behaviour and other factors associated with longest quit attempt and the use of nicotine replacement therapy (NRT) and stop-smoking medication (SSM) in a population of Indigenous Australian women of reproductive age. DESIGN, SETTING AND PARTICIPANTS A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16-49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. MAIN OUTCOME MEASURES Quitting experience: attempt to cut down, time since last quit attempt, longest period without smoking, attempt to cut down during last quit attempt, any use of NRT and/or SSM. RESULTS Most of the 428 participating women (302 [70.6%]) reported using an Aboriginal health service. Younger women (16-20-year-olds) smoked fewer cigarettes daily (24/42 [57.1%], 0-5 cigarettes per day), waited longer to smoke after waking (20/42 [47.6%], > 60 minutes after waking), and were categorised as low smoking dependency compared with those aged 35 years and over. One-third of women (153 [35.7%]) had ever used NRT and/or SSM. A greater proportion of older women (35-49-year-olds) had sustained a quit attempt for years (62/149 [45.6%]) and reported trying NRT and/or SSM (78/149 [52.4%]) than women in younger age groups. Quitting suddenly rather than gradually was significantly associated with sustained abstinence (prevalence ratio, 1.27 [95% CI, 1.10-1.48]). Among women who had never used NRT or SSM, most (219/275 [79.6%]) reported reasons for this in the category of attitudes and beliefs. NRT and SSM use was also more likely among women who were confident talking to their doctor about quitting (odds ratio, 2.50 [95% CI, 1.23-5.10]) and those who received most of their information from a health professional (odds ratio, 1.71 [95% CI, 1.11-2.63]). CONCLUSION Aboriginal and Torres Strait Islander women want to quit smoking and are making attempts to quit. Quitting suddenly, rather than reducing cigarette consumption, is associated with increased sustained abstinence. Health providers can enable access and uptake of NRT and/or SSM and should recognise that NRT and/or SSM use may change over time. Consistent messaging, frequent offers of smoking cessation support, and access to a range of smoking cessation supports should be provided to Aboriginal and Torres Strait Islander women to enable them to be smoke-free.
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Affiliation(s)
| | - Eden Barrett
- National Centre for Epidemiology and Population Health, Australian National UniversityCanberraACT
| | - Christina Heris
- National Centre for Epidemiology and Population Health, Australian National UniversityCanberraACT
| | | | - Catherine Chamberlain
- University of MelbourneMelbourneVIC
- Judith Lumley Centre, La Trobe UniversityMelbourneVIC
| | - Paul Hussein
- Yerin Eleanor Duncan Aboriginal Health CentreWyongNSW
| | - Hayley Longbottom
- Waminda South Coast Women’s Health and Welfare Aboriginal CorporationNowraNSW
| | - Shanell Bacon
- Nunyara Aboriginal Health Clinics, Central Coast Local Health DistrictGosfordNSW
| | - Raglan Maddox
- National Centre for Epidemiology and Population Health, Australian National UniversityCanberraACT
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Massi L, Hickey S, Maidment SJ, Roe Y, Kildea S, Nelson C, Kruske S. Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study. Int J Equity Health 2021; 20:212. [PMID: 34563171 PMCID: PMC8465693 DOI: 10.1186/s12939-021-01519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations’ and other babies in Australia. The program is based on the United States’ Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting. Methods A qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate ‘yarning’ method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis. Results Seventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over ‘ownership’ of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums. Conclusion Effective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context.
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Affiliation(s)
- Luciana Massi
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Sophie Hickey
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia.
| | - Sarah-Jade Maidment
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Carmel Nelson
- Institute of Urban Indigenous Health, Brisbane, QLD, Australia
| | - Sue Kruske
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
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Bovill M, Chamberlain C, Bennett J, Longbottom H, Bacon S, Field B, Hussein P, Berwick R, Gould G, O’Mara P. Building an Indigenous-Led Evidence Base for Smoking Cessation Care among Aboriginal and Torres Strait Islander Women during Pregnancy and Beyond: Research Protocol for the Which Way? Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1342. [PMID: 33540747 PMCID: PMC7908248 DOI: 10.3390/ijerph18031342] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/19/2021] [Accepted: 01/27/2021] [Indexed: 12/21/2022]
Abstract
Strong and healthy futures for Aboriginal and Torres Strait Islander people requires engagement in meaningful decision making which is supported by evidence-based approaches. While a significant number of research publications state the research is co-designed, few describe the research process in relation to Indigenous ethical values. Improving the health and wellbeing of Aboriginal and Torres Strait Islander mothers and babies is crucial to the continuation of the oldest living culture in the world. Developing meaningful supports to empower Aboriginal and Torres Strait Islander mothers to quit smoking during pregnancy is paramount to addressing a range of health and wellbeing outcomes. Aboriginal and Torres Strait Islander women have called for non-pharmacological approaches to smoking cessation during pregnancy. We describe a culturally responsive research protocol that has been co-designed and is co-owned with urban and regional Aboriginal communities in New South Wales. The project has been developed in line with the AH&MRC's (Aboriginal Health & Medical Research Council) updated guidelines for ethical research with Aboriginal and Torres Strait Islander communities. Ethics approvals have been granted by AH&MRC #14541662 University of Newcastle HREC H-2020-0092 and the Local Health District ethics committee 2020/ETH02095. Results will be disseminated through peer reviewed articles, community reports, infographics, and online social media content.
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Affiliation(s)
- Michelle Bovill
- School of Health and Medicine, University of Newcastle, UON, Callaghan, NSW 2308, Australia; (J.B.); (G.G.); (P.O.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
| | | | - Jessica Bennett
- School of Health and Medicine, University of Newcastle, UON, Callaghan, NSW 2308, Australia; (J.B.); (G.G.); (P.O.)
| | - Hayley Longbottom
- Waminda- South Coast Women’s Health and Welfare Aboriginal Coorporation, Nowra, NSW 2541, Australia;
| | - Shanell Bacon
- Nunyara Aboriginal Health Unit, Gosford, NSW 2250, Australia;
| | - Belinda Field
- Yerin-Eleanor Duncan Aboriginal Health Centre, Wyong, NSW 2259, Australia; (B.F.); (P.H.)
| | - Paul Hussein
- Yerin-Eleanor Duncan Aboriginal Health Centre, Wyong, NSW 2259, Australia; (B.F.); (P.H.)
| | - Robert Berwick
- Tamworth Aboriginal Medical Centre, Tamworth, NSW 2340, Australia;
| | - Gillian Gould
- School of Health and Medicine, University of Newcastle, UON, Callaghan, NSW 2308, Australia; (J.B.); (G.G.); (P.O.)
- Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
| | - Peter O’Mara
- School of Health and Medicine, University of Newcastle, UON, Callaghan, NSW 2308, Australia; (J.B.); (G.G.); (P.O.)
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Daly JB, Dowe S, Tully B, Tzelepis F, Lecathelinais C, Gillham K. Acceptance of smoking cessation support and quitting behaviours of women attending Aboriginal Maternal and Infant Health Services for antenatal care. BMC Pregnancy Childbirth 2021; 21:85. [PMID: 33499811 PMCID: PMC7836151 DOI: 10.1186/s12884-021-03569-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acceptance of smoking cessation support during antenatal care and associated quitting behaviours of pregnant Aboriginal women or women having an Aboriginal baby has not been investigated. This study aimed to determine, among pregnant women who smoke and attended AMIHS for their antenatal care: 1. The acceptance of smoking cessation support, factors associated with acceptance and barriers to acceptance; 2. The prevalence of quitting behaviours and factors associated with quitting behaviours. METHODS A cross-sectional telephone survey of women who attended 11 AMIHSs for their antenatal care during a 12 month period in the Hunter New England Local Health District of New South Wales. RESULTS One hundred women contacted consented to complete the survey (76%). Of those offered cessation support, 68% accepted NRT, 56% accepted follow-up support and 35% accepted a Quitline referral. Participants accepting NRT had greater odds of quitting smoking at least twice during the antenatal period [OR = 6.90 (CI: 1.59-29.7)] and those reporting using NRT for greater than eight weeks had six times the odds of quitting smoking for one day or more [OR = 6.07 (CI: 1.14-32.4)]. CONCLUSIONS Aboriginal women or women having an Aboriginal baby who smoke make multiple attempts to quit during pregnancy and most women accept smoking cessation support when offered by their antenatal care providers. Acceptance of care and quitting success may be improved with increased focus on culturally appropriate care and enhanced training of antenatal care providers to increase skills in treating nicotine addiction and supporting women to use NRT as recommended by treatment guidelines.
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Affiliation(s)
- Justine B Daly
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia. .,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.
| | - Sarah Dowe
- NSW Rural Doctors Network, 53 Cleary Street, Hamilton, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia.,Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales, 2305, Australia
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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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General practitioner and obstetrician views on system changes to improve smoking cessation care in pregnancy in Australia: a cross-sectional survey. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AbstractIntroductionSystemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training.AimAssess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses.MethodsNational cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians).ResultsN = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%).ConclusionGPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates.
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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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11
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Bovill M. What ngidhi yinaaru nhal yayi (this woman told me) about smoking during pregnancy. Med J Aust 2020; 212:358-359.e1. [PMID: 32105340 DOI: 10.5694/mja2.50523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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12
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Small S, Porr C, Swab M, Murray C. Experiences and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2019; 16:385-452. [PMID: 29419622 DOI: 10.11124/jbisrir-2017-003377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this review was to identify and synthesize the best available evidence to address two questions: i) what is the experience of smoking during pregnancy for Indigenous women? and ii) what are the smoking cessation needs of Indigenous women who smoke during pregnancy? INTRODUCTION Smoking during pregnancy not only affects pregnant women's general health but also causes such serious problems as pre-term delivery, low birth weight, and sudden infant death. Rates of smoking during pregnancy are particularly high among Indigenous women. Learning about Indigenous women's experiences of smoking during pregnancy and associated smoking cessation needs is important to providing informed health care to them. INCLUSION CRITERIA The participants of interest were Indigenous women who smoked during a current or past pregnancy. The phenomena of interest were the experiences of smoking during pregnancy for Indigenous women and the smoking cessation needs of Indigenous women during pregnancy. The context was any community worldwide where pregnant Indigenous women live. Studies considered for this review were those in which qualitative data were gathered and analysed on the phenomena of interest, including mixed methods research. METHODS A comprehensive search was conducted for published studies in academic databases (i.e. PubMed, CINAHL, PsycINFO, Embase, Sociological Abstracts, SocINDEX, and Web of Science), unpublished studies in sources of gray literature (i.e. ProQuest Dissertations and Theses, OAIster, LILACS, MedNar, Google, Google Scholar, OpenGrey and relevant websites), and any additional studies in reference lists. Language and date limiters were not applied. The searches included all studies globally and were carried out on October 31, 2016. Studies that met the inclusion criteria were assessed for methodological quality by two reviewers independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Descriptive details of each study accepted for this review were extracted in accordance with the elements of the JBI Data Extraction Form for Qualitative Research. The research findings that were relevant to the phenomena of interest and had participant voice were extracted from each included study and synthesized using the JBI meta-aggregative approach. The synthesized findings were assigned confidence scores in accordance with the JBI ConQual approach. RESULTS Thirteen studies were included in this review following careful consideration of the methodological quality of each study. The studies yielded a total of 116 research findings, which were grouped into 19 categories and then aggregated to form five synthesized findings. Confidence in the findings was determined to be low to very low (see ConQual Summary of Findings). CONCLUSION There is a small body of research evidence on Indigenous women's experiences of smoking during pregnancy and their smoking cessation needs. Confidence in the synthesized findings is constrained due to methodological limitations in many of the primary studies included in this review, along with mixed credibility of the research findings from across primary studies.
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Affiliation(s)
- Sandra Small
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Caroline Porr
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Cynthia Murray
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
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Barriers and facilitators to smoking cessation within pregnant Aboriginal and/or Torres Strait Islander women: An integrative review. Midwifery 2019; 73:49-61. [DOI: 10.1016/j.midw.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/26/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
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Walker RC, Graham A, Palmer SC, Jagroop A, Tipene-Leach DC. Understanding the experiences, perspectives and values of indigenous women around smoking cessation in pregnancy: systematic review and thematic synthesis of qualitative studies. Int J Equity Health 2019; 18:74. [PMID: 31118025 PMCID: PMC6532160 DOI: 10.1186/s12939-019-0981-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/10/2019] [Indexed: 12/25/2022] Open
Abstract
Background The prevalence of smoking during pregnancy among indigenous women approaches 50% and is associated with sudden infant death, pregnancy loss, preterm delivery, low birth weight, and anatomical deformity. This study aims to synthesise qualitative studies by reporting experiences, perceptions, and values of smoking cessation among pregnant indigenous women to inform potential interventions. Method A highly-sensitive search of MEDLINE, Embase, PsychINFO, and CINAHL, in conjunction with analysis of Google Scholar and reference lists of related studies was conducted in March 2018. We utilised two methods (thematic synthesis and an indigenous Māori analytical framework) in parallel to analyse data. Completeness of reporting in studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) framework. Results We included seven studies from Australia and New Zealand involving 250 indigenous women. Three themes were identified. Realising well-being and creating agency included giving the best start to baby, pride in being a healthy mum, female role models, and family support. Understanding the drivers for smoking included the impact of stress and chaos that hindered prioritisation of self-care, the social acceptability of smoking, guilt and feeling judged, and inadequate information about the risks of smoking. Indigenous women strongly preferred culturally responsive approaches to smoking cessation, placing value on programs designed specifically for and by indigenous people, that were accessible, and provided an alternative to smoking. Conclusion Future interventions and smoking cessation programmes might be more effective and acceptable to indigenous women and families when they harness self-agency and the desire for a healthy baby, recognise the high value of indigenous peer involvement, and embed a social focus in place of smoking as a way to maintain community support and relationships. Development and evaluation of smoking cessation programs for pregnant indigenous women and families is warranted.
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Affiliation(s)
- Rachael C Walker
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand.
| | - Aria Graham
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand.,Whakauae Research for Maori Health and Development, Whanganui, 4541, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, 8140, New Zealand
| | - Anita Jagroop
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand
| | - David C Tipene-Leach
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand
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Hefler M, Kerrigan V, Freeman B, Boot GR, Thomas DP. Using Facebook to reduce smoking among Australian Aboriginal and Torres Strait Islander people: a participatory grounded action study. BMC Public Health 2019; 19:615. [PMID: 31113480 PMCID: PMC6528248 DOI: 10.1186/s12889-019-6918-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is limited evidence for the effectiveness of social media to promote healthy behaviour among Indigenous Australians, including to reduce smoking. Social media has significant potential to stimulate interpersonal influence to quit, however an important knowledge gap is how and what content people choose to share with friends and family. This paper explores the decision making processes of community members for sharing tobacco control content with family and friends on Facebook. METHODS Community researchers were paid to choose and share at least one tobacco control post per week for a period of 6 months on their personal Facebook page. They documented reasons for their choices, which were coded and analysed to determine features of messages most likely to be shared, and salient considerations in the decision-making process. RESULTS Posts which are child-focused, feature Indigenous content, and are perceived as practical, relevant and credible, with a direct and unambiguous message, were most likely to be shared. Posts which included disgusting imagery about health impacts, were focused on the environment, or were ambiguous or sarcastic were less likely to be shared. Decisions were also based on whether content was perceived to contain new information, to be helpful for their friends, and to be consistent with the participant's online identity, as well as the perceived sensitivity of content. The potential impact on expensive mobile data for videos was also a factor. CONCLUSIONS When designing tobacco control messages to be shared on social media, health promoters should take into account how information will align with positive self-image and can contribute to social capital among the intended audience, and generate interpersonal engagement. Content should complement, rather than attempt to replicate, some message features that are effective on traditional broadcast media. This study shows the potential for health services to incorporate a strategy of using paid local social media 'champions' or 'ambassadors' to disseminate tobacco control messages on Facebook through community networks.
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Affiliation(s)
- Marita Hefler
- Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Vicki Kerrigan
- Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Becky Freeman
- Prevention Research Collaboration, School of Public Health, Charles Perkins Centre, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia
| | - Gordon Robert Boot
- Miwatj Health Aboriginal Corporation, PO Box 519, Nhulunbuy, NT 0881 Australia
| | - David P. Thomas
- Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
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Gould GS, Bovill M, Pollock L, Bonevski B, Gruppetta M, Atkins L, Carson-Chahhoud K, Boydell KM, Gribbin GR, Oldmeadow C, Hall A, Bar-Zeev Y, Bar-Zeev Y. Feasibility and acceptability of Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy multicomponent implementation intervention and study design for Australian Indigenous pregnant women: A pilot cluster randomised step-wedge trial. Addict Behav 2019; 90:176-190. [PMID: 30412909 DOI: 10.1016/j.addbeh.2018.10.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many health providers (HPs) lack knowledge, confidence, optimism and skills in addressing smoking with pregnant women. This study aimed to explore the feasibility and acceptability of a) a co-designed multi-component intervention for HPs at Aboriginal Medical Services (AMSs) in culturally-targeted pregnancy-specific smoking cessation care and b) the study design. METHODS Using a randomised step-wedge cluster design, the Indigenous Counselling And Nicotine (ICAN) QUIT in Pregnancy Trial was evaluated across six AMSs in three Australian states. HPs were provided educational resource packages including live interactive webinars, treatment manuals, patient resources, carbon monoxide (CO) meters, and oral Nicotine Replacement Therapy (NRT). Feasibility was assessed through recruitment and retention rates of both pregnant women (12-weeks) and HPs (end of study) as well as the potential to improve women's quit rates. Qualitative interviews with staff post-trial explored acceptability of the intervention and study, based on capability, opportunity and motivation from the Behaviour Change Wheel. RESULTS Pregnant women (n = 22; 47% (95% CI: 32%, 63%) eligible) and HPs (n = 50; 54% (95% CI: 44%, 64%) eligible) were recruited over 6 months with retention rates of 77% (95% CI: 57%, 90%) and 40% (95% CI: 28%, 54%) respectively. Self-reported 12-week 7-day point-prevalence abstinence was 13.6% (n = 3) and validated abstinent with CO readings ≤6 ppm. Staff interviewed regarding intervention implementation highlighted the importance of provision and use of resources, including training materials, patient resources, CO meters and oral NRT. Resources helped increase capability and opportunity, restructure the environment, and provided social comparison and modelling. Staff were motivated by greater engagement with pregnant women and seeing the women's reductions in CO readings. Having the intervention at the AMSs improved organisational capacity to engage with pregnant women. Staff reported changes to their routine practice that were potentially sustainable. Recommendations for improvement to the implementation of the intervention and research included reducing training length and the tasks related to conducting the study. CONCLUSION ICAN QUIT in Pregnancy was a pilot study with the ability to enrol Indigenous women. It was feasible to implement and acceptable to most staff of the AMSs in three states, with modifications recommended. Smoking in pregnancy is a key challenge for Indigenous health. The intervention needs to be evaluated through a methodologically rigorous fully-powered study to determine the efficacy of outcomes for women. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12616001603404. Registered 21 November 2016 - retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371778.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yael Bar-Zeev
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
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17
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Bovill M, Bar-Zeev Y, Gruppetta M, Clarke M, Nicholls K, O'Mara P, Bonevski B, Reath J, Gould G. Giri-nya-la-nha (talk together) to explore acceptability of targeted smoking cessation resources with Australian Aboriginal women. Public Health 2018; 176:149-158. [PMID: 30392971 DOI: 10.1016/j.puhe.2018.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/18/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To engage with health providers and Aboriginal women to understand what educational resources they want and need to support quit smoking attempts during pregnancy in order to develop a comprehensive evidence-based intervention. STUDY DESIGN Resources were developed in partnership with Aboriginal people, communities and academics with the aim to be inclusive of diverse communities. We then recruited Aboriginal women of various ages for yarning circles (focus groups) held in three Australian states to explore the acceptability of the resources and seeking further guidance as to the needs of Aboriginal women to support smoking cessation during pregnancy. METHODS Yarning circles were recorded and transcribed, and data were analysed independently by two researchers. Responses were coded using predetermined themes and further general inductive analysis for emergent themes. RESULTS Twenty-four Aboriginal women reflected on the resources they included: one pregnant woman, 15 mothers and eight elders. Predetermined themes of attraction, comprehension, cultural acceptability, graphics and layout, persuasion and self-efficacy were explored. Women suggested the following: resources need to be visually attractive and interactive to enhance self-efficacy; additional scientific content on health consequences of smoking and combining with non-pharmacological approaches to quitting. CONCLUSION Indigenous peoples prefer culturally targeted messages. However, developing effective Aboriginal health promotion requires more than a 'culturally appropriate' adaptation of mainstream resources. Consideration needs to be given to the diversity of Aboriginal communities when developing effective, evidence-based interventions. Aboriginal women are calling for innovative and interactive resources that enhance self-efficacy; the use of videos to explain medical and informational brochure content is well received. Requests for non-pharmacological cessation options were reported in New South Wales and Queensland and should be further explored.
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Affiliation(s)
- M Bovill
- School of Medicine and Public Health, University of Newcastle, NSW, Australia.
| | - Y Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - M Gruppetta
- Wollotuka Institute, University of Newcastle, NSW, Australia
| | - M Clarke
- OBGYN, Clarence Specialist Clinic, Australia
| | - K Nicholls
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - P O'Mara
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - B Bonevski
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - J Reath
- School of Medicine, Western Sydney University, Australia
| | - G Gould
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
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Berger I, Mooney-Somers J. Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review. Nicotine Tob Res 2018; 19:1408-1417. [PMID: 27613909 DOI: 10.1093/ntr/ntw216] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 08/26/2016] [Indexed: 12/24/2022]
Abstract
Introduction Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities. Aims To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking. Methods We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations. Results We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences. Conclusions Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men. Implications This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.
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Affiliation(s)
- Israel Berger
- Centre for Values, Ethics and Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Waller A, Bryant J, Cameron E, Galal M, Symonds I, Sanson-Fisher R. Screening for recommended antenatal risk factors: How long does it take? Women Birth 2018; 31:489-495. [PMID: 29366711 DOI: 10.1016/j.wombi.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/13/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Detection and management of antenatal risk factors is critical for quality care. AIMS To determine (1) women's views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario. METHODS In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors. FINDINGS Most women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52min. More time was spent discussing clinical (11min) than lifestyle factors (4min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8min per woman. Average time required for detecting and offering assistance to manage risk factors is 60min per average risk woman. CONCLUSION Women are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be 'at-risk' for multiple factors.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Emilie Cameron
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Mohamed Galal
- Department of Obstetrics and Gynaecology, Hunter New England Local Health District, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
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A Novel Approach to Transforming Smoking Cessation Practice for Pregnant Aboriginal Women and Girls Living in the Pilbara. Healthcare (Basel) 2018; 6:healthcare6010010. [PMID: 29360761 PMCID: PMC5872217 DOI: 10.3390/healthcare6010010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/08/2017] [Accepted: 12/29/2017] [Indexed: 11/30/2022] Open
Abstract
Tobacco smoking during pregnancy contributes to a range of adverse perinatal outcomes; but is a potentially modifiable behavior. In Australia Aboriginal and Torres Strait Islander women face a range of barriers that hinder; rather than support smoking cessation. Few smoking cessation programs consider the broader social determinants of women’s lives; the gendered nature of these or the complexities which impinge on behavior change in the presence of social and economic disadvantage and substantial individual and intergenerational trauma. Drawing on the salient gender and trauma-informed literature this paper describes the rationale underpinning formative research which will inform the design of a localized, culturally meaningful smoking cessation program for Aboriginal women living in the Hedland and Western Desert communities of the remote Pilbara region of Western Australia. We contend that a women-centered, trauma-informed approach to smoking cessation has much to offer those seeking to address this critical public health issue
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Gould GS, Bar-Zeev Y, Bovill M, Atkins L, Gruppetta M, Clarke MJ, Bonevski B. Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women. Implement Sci 2017; 12:114. [PMID: 28915815 PMCID: PMC5602934 DOI: 10.1186/s13012-017-0645-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS. METHOD The Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.'s "Behaviour Change Wheel" guide. RESULTS Targets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients' capability, opportunity and motivation. CONCLUSIONS The ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Lou Atkins
- University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Maree Gruppetta
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Marilyn J Clarke
- Clarence Specialist Clinic, 86 Through Street, South Grafton, NSW, 2460, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Chamberlain C, Perlen S, Brennan S, Rychetnik L, Thomas D, Maddox R, Alam N, Banks E, Wilson A, Eades S. Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples. Syst Rev 2017; 6:135. [PMID: 28693556 PMCID: PMC5504765 DOI: 10.1186/s13643-017-0520-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014-15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities. METHODS MEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement. RESULTS Twenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or 'pubs, clubs and restaurants'. CONCLUSIONS There is limited Indigenous-specific evidence for most tobacco interventions. A 'comprehensive approach' incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.
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Affiliation(s)
- Catherine Chamberlain
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004 Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
- Judith Lumley Centre, La Trobe University, 217 Franklin St, Melbourne, VIC 3000 Australia
- Healthy Mothers, Healthy Families Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
- The Australian Prevention Partnership Centre, 13/235 Jones St, Ultimo, NSW 2007 Australia
| | - Susan Perlen
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004 Australia
- Healthy Mothers, Healthy Families Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Flemington Road, Parkville, VIC 3052 Australia
| | - Sue Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, 160 Oxford St, Darlinghurst, NSW 2010 Australia
- The Australian Prevention Partnership Centre, 13/235 Jones St, Ultimo, NSW 2007 Australia
| | - David Thomas
- Tobacco Control Research, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811 Australia
| | - Raglan Maddox
- Well Living House, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 209 Victoria St, Toronto, Canada
- Faculty of Health, University of Canberra, University Dr, Bruce, Canberra, ACT 2617 Australia
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Noore Alam
- Prevention Division, Department of Health, Queensland Government, 15 Butterfield St, Herston, QLD 4006 Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Mills Road, Canberra, ACT 2601 Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, 13/235 Jones St, Ultimo, NSW 2007 Australia
- Menzies Centre for Health Policy, University of Sydney, Camperdown, NSW 2006 Australia
| | - Sandra Eades
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, VIC 3004 Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
- The Australian Prevention Partnership Centre, 13/235 Jones St, Ultimo, NSW 2007 Australia
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23
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Gould GS, Lim LL, Mattes J. Prevention and Treatment of Smoking and Tobacco Use During Pregnancy in Selected Indigenous Communities in High-Income Countries of the United States, Canada, Australia, and New Zealand: An Evidence-Based Review. Chest 2017; 152:853-866. [PMID: 28694200 DOI: 10.1016/j.chest.2017.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022] Open
Abstract
Tobacco smoking during pregnancy is the most important modifiable risk factor for adverse pregnancy outcomes and long-term health complications for mother and baby. Tobacco use during pregnancy has decreased in high-income countries but not in Indigenous women in Australia, New Zealand, the United States, and Canada. This evidence-based review focuses on tobacco use among Indigenous pregnant women in high-income countries that share a history of European colonization. Indigenous women are more likely to use tobacco because of socioeconomic disadvantage, social norms, and poor access to culturally appropriate tobacco cessation support. Complications arising from tobacco smoking during pregnancy, such as low birth weight, prematurity, perinatal death, and sudden infant death syndrome, are much higher in Indigenous populations. Effective approaches to cessation in pregnant nonindigenous women involves behavioral counseling, with or without nicotine replacement therapy (NRT). Higher nicotine metabolism during pregnancy and poor adherence may affect therapeutic levels of NRT. Only two randomized trials were conducted among Indigenous women: neither found a statistically significant difference in cessation rates between the treatment and comparison arms. Considerations should be given to (1) whole life course approaches to reduce tobacco use in Indigenous women, (2) prohibiting tobacco promotion and reducing access to alcohol for minors to prevent smoking initiation in Indigenous youth, and (3) training health-care professionals in culturally appropriate smoking cessation care to improve access to services. It is critical to ensure acceptability and feasibility of study designs, consult with the relevant Indigenous communities, and preempt implementation challenges. Research is needed into the effect of reducing or stopping smoking during pregnancy when using NRT on subsequent maternal and infant outcomes.
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Affiliation(s)
- Gillian S Gould
- Priority Reseach Centre for Brain and Mental Health Research, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Ling Li Lim
- Priority Reseach Centre for Brain and Mental Health Research, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute and University of Newcastle, and Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia
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Bovill M, Gruppetta M, Cadet-James Y, Clarke M, Bonevski B, Gould GS. Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study. Women Birth 2017; 31:10-16. [PMID: 28689764 DOI: 10.1016/j.wombi.2017.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 11/17/2022]
Abstract
AIM To gather Aboriginal women's stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation support during pregnancy. METHODS Qualitative data were collected through use of yarning methodology between August 2015 and January 2016 by an Aboriginal Researcher with experience in social and community services. A short on-line survey was used to collect quantitative data. Interviews only recorded the therapeutic yarning process, which ranged from 9 to 45min duration, averaging 30min. Audio-recorded interviews were transcribed and independently coded. A general inductive analysis was used to determine emergent themes. RESULTS Twenty Aboriginal women between 17-38 years of age, who were pregnant or recently given birth, living in the Hunter New England (HNE) area took part. Eleven women were still smoking; nine had quit. Most were highly aware of the implications of smoking for their babies. Major themes identified for accepting support were: ambivalence towards a need for support, health professional advice, reduction in smoking, and attitudes to Nicotine Replacement Therapy (NRT). Women reported being advised to cut down, rather than to quit; reducing consumption may be a barrier to accepting NRT. Women recommended enhanced clinical support and Aboriginal community engagement in cessation care. DISCUSSION/CONCLUSIONS Aboriginal women in the HNE area reported quitting or reducing their cigarette intake during pregnancy. Health Professionals working with Aboriginal women during pregnancy should give consistent messages to quit smoking completely, and offer increased, ongoing and extensive smoking cessation support to Aboriginal mothers. Clinical practices could partner with Aboriginal communities to support the delivery of smoking cessation services.
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Affiliation(s)
- M Bovill
- School of Medicine & Public Health, University of Newcastle, NSW, Australia.
| | - M Gruppetta
- Wollotuka, University of Newcastle, NSW, Australia
| | - Y Cadet-James
- Indigenous Centre, James Cook University, QLD, Australia
| | - M Clarke
- OBGYN, Clarence Specialist Clinic, NSW, Australia
| | - B Bonevski
- School of Medicine & Public Health, University of Newcastle, NSW, Australia
| | - G S Gould
- School of Medicine & Public Health, University of Newcastle, NSW, Australia
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Gould GS, Bovill M, Chiu S, Bonevski B, Oldmeadow C. Exploring an adapted Risk Behaviour Diagnosis Scale among Indigenous Australian women who had experiences of smoking during pregnancy: a cross-sectional survey in regional New South Wales, Australia. BMJ Open 2017; 7:e015054. [PMID: 28566365 PMCID: PMC5729996 DOI: 10.1136/bmjopen-2016-015054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Explore Aboriginal women's responses to an adapted Risk Behaviour Diagnosis (RBD) Scale about smoking in pregnancy. METHODS AND DESIGN An Aboriginal researcher interviewed women and completed a cross-sectional survey including 20 Likert scales. SETTING Aboriginal Community Controlled Health Services, community groups and playgroups and Aboriginal Maternity Services in regional New South Wales, Australia. PARTICIPANTS Aboriginal women (n=20) who were pregnant or gave birth in the preceding 18 months; included if they had experiences of smoking or quitting during pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes: RBD constructs of perceived threat and perceived efficacy, dichotomised into high versus low. Women who had quit smoking, answered retrospectively. SECONDARY OUTCOME MEASURES smoking status, intentions to quit smoking (danger control), protection responses (to babies/others) and fear control responses (denial/refutation). Scales were assessed for internal consistency. A chart plotted responses from low to high efficacy and low to high threat. RESULTS RBD Scales had moderate-to-good consistency (0.67-0.89 Cronbach's alpha). Nine women had quit and 11 were smoking; 6 currently pregnant and 14 recently pregnant. Mean efficacy level 3.9 (SD=0.7); mean threat 4.3 (SD=0.7). On inspection, a scatter plot revealed a cluster of 12 women in the high efficacy-high threat quadrant-of these 11 had quit or had a high intention of quitting. Conversely, a group with low threat-low efficacy (5 women) were all smokers and had high fear control responses: of these, 4 had low protection responses. Pregnant women had a non-significant trend for higher threat and lower efficacy, than those previously pregnant. CONCLUSION Findings were consistent with a previously validated RBD Scale showing Aboriginal smokers with high efficacy-high threat had greater intentions to quit smoking. The RBD Scale could have diagnostic potential to tailor health messages. Longitudinal research required with a larger sample to explore associations with the RBD Scale and quitting.
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Affiliation(s)
- Gillian Sandra Gould
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Michelle Bovill
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Simon Chiu
- Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, 1/1 Kookaburra Circuit, New South Wales, Australia
| | - Billie Bonevski
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, 1/1 Kookaburra Circuit, New South Wales, Australia
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Gould GS, Bovill M, Clarke MJ, Gruppetta M, Cadet-James Y, Bonevski B. Chronological narratives from smoking initiation through to pregnancy of Indigenous Australian women: A qualitative study. Midwifery 2017; 52:27-33. [PMID: 28570858 DOI: 10.1016/j.midw.2017.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/23/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE One in two Indigenous Australian pregnant women smoke, yet little is known about their trajectory of smoking. This study aimed to explore Aboriginal women's narratives from starting smoking through to pregnancy. METHODS A female Aboriginal Researcher conducted individual face-to-face interviews with 20 Aboriginal women from New South Wales, Australia. Recruitment, through Aboriginal services and community networks, continued until saturation was reached. Audio-recorded transcripts were independently open coded by two researchers, inductively analysed and reported using a three-dimensional structure of looking backwards, forwards, inwards, outwards and a sense of place, to elucidate the chronology of events, life stages, characters, environments, and turning points of the stories. RESULTS A chronology emerged from smoking initiation in childhood, coming of age, becoming pregnant, through to attempts at quitting, and relapse post-partum. Several new themes emerged: the role mothers play in women's smoking and quitting; the contribution of nausea to spontaneous quitting; depression as a barrier to quitting; and the hopes of women for their own and their children's future. The epiphany of pregnancy was a key turning point for many - including the interplay of successive pregnancies; and the intensity of expressed regret. CONCLUSIONS Aboriginal women report multiple influences in the progression of early smoking to pregnancy and beyond. Potential opportunities to intervene include: a) childhood, coming of age, pregnancy, post-natal, in-between births; b) key influencers; c) environments, and d) targeting concurrent substance use. Morning sickness appears to be a natural deterrent to continued smoking. Depression, and its relationship to smoking and quitting in Australian Indigenous pregnant women, requires further research.
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Affiliation(s)
- Gillian S Gould
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Michelle Bovill
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Marilyn J Clarke
- Clarence Specialist Clinic, Through Street, South Grafton, New South Wales 2460, Australia
| | - Maree Gruppetta
- Wollotuka Institute, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Yvonne Cadet-James
- Indigenous Centre, James Cook University, Townsville, Queensland 4811, Australia
| | - Billie Bonevski
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
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Gould GS, Patten C, Glover M, Kira A, Jayasinghe H. Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review. Nicotine Tob Res 2017; 19:506-517. [PMID: 28403465 PMCID: PMC5896479 DOI: 10.1093/ntr/ntw288] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 02/08/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies. METHODS As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research. RESULTS Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches. CONCLUSIONS Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted. IMPLICATIONS Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Marewa Glover
- School of Public Health, College of Health, Massey University, Auckland, New Zealand
| | - Anette Kira
- Independent Researcher, Manawatu, New Zealand
| | - Harshani Jayasinghe
- University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
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Bovill M, Bar-Zeev Y, Gruppetta M, O'Mara P, Cowling B, Gould GS. Collective and negotiated design for a clinical trial addressing smoking cessation supports for Aboriginal and Torres Strait Islander mothers in NSW, SA and Qld – developing a pilot study. Aust J Prim Health 2017; 23:497-503. [DOI: 10.1071/py16140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/16/2017] [Indexed: 11/23/2022]
Abstract
Tobacco smoking leads to one in five deaths of Aboriginal Australians and accounts for 17% of the reversible health gap. One in two Aboriginal women are reported to smoke during pregnancy, with no effective strategies currently available for health practitioners to utilise for supporting Aboriginal women. Aboriginal community participation in primary health research is crucial to implementing ethical research, with a clear benefit to the people and communities involved. However, currently there is little evidence on how Aboriginal programs and interventions are being developed in partnership with Aboriginal people and communities. ‘Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy’ aims to address the prevalence of smoking during pregnancy by enhancing health providers’ training in offering evidence-based smoking cessation care to Aboriginal mothers during pregnancy. This paper outlines the participatory research approach adopted for the developmental phase of the ‘ICAN QUIT in Pregnancy’ project developed in partnership with two Aboriginal Community-Controlled Health Services in NSW, and negotiation processes undertaken to implement a pilot intervention across NSW, SA and Qld.
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Waller A, Bryant J, Cameron E, Galal M, Quay J, Sanson-Fisher R. Women's perceptions of antenatal care: are we following guideline recommended care? BMC Pregnancy Childbirth 2016; 16:191. [PMID: 27464567 PMCID: PMC4963960 DOI: 10.1186/s12884-016-0984-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background Detection and management of antenatal risk factors is critical for improved maternal and infant outcomes. This study describes the proportion of pregnant women who self-reported being screened for and offered advice to manage antenatal risk factors in line with antenatal care recommendations; and the characteristics associated with rates of screening. Methods A survey was undertaken with 223 (64 % of eligible) pregnant women recruited from an outpatient obstetrics clinic at a public hospital. Participants self-reported whether they were: (i) screened for 23 guideline-recommended risk factors during their antenatal visit; (ii) offered assistance to manage identified risk factor(s); and (iii) received assistance that was of benefit. Association between rate of screening and participant characteristics was examined using multivariate quantile regression. Results Overall, 23 % of women reported that they were asked about every risk factor. Weight gain (48 %), diet (60 %) and oral health (31 %) were least frequently screened risk factors. The number of women who reported they were offered advice to manage identified risks and the value of that advice was perceived by women as suboptimal. Those women receiving shared care between a midwife and general practitioner, of Aboriginal or Torres Strait Islander descent, and without private health insurance reported being screened for a greater number of risk factors. Conclusions Pregnant women report suboptimal rates of screening and management of antenatal risk factors. Initiatives to improve consistency in detection of antenatal risk factors and the application of appropriate interventions to manage those risk factors that are detected are required.
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Affiliation(s)
- Amy Waller
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Emilie Cameron
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Mohamed Galal
- Department of Obstetrics and Gynaecology, Hunter New England Local Health District, Newcastle, NSW, Australia.,Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia
| | - Juliana Quay
- Department of Obstetrics and Gynaecology, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Gould GS, Cadet-James Y, Clough AR. Getting over the shock: taking action on Indigenous maternal smoking. Aust J Prim Health 2016; 22:276-282. [PMID: 27426721 DOI: 10.1071/py15066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 02/21/2016] [Indexed: 11/23/2022]
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.
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Affiliation(s)
- Gillian S Gould
- Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Yvonne Cadet-James
- Australian Aboriginal and Torres Strait Islander Centre, James Cook University, Townsville, Qld 4811, Australia
| | - Alan R Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Qld 4870, Australia
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Thurber KA, Dobbins T, Kirk M, Dance P, Banwell C. Early Life Predictors of Increased Body Mass Index among Indigenous Australian Children. PLoS One 2015; 10:e0130039. [PMID: 26075400 PMCID: PMC4468174 DOI: 10.1371/journal.pone.0130039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/15/2015] [Indexed: 02/01/2023] Open
Abstract
Aboriginal and Torres Strait Islander Australians are more likely than non-Indigenous Australians to be obese and experience chronic disease in adulthood--conditions linked to being overweight in childhood. Birthweight and prenatal exposures are associated with increased Body Mass Index (BMI) in other populations, but the relationship is unclear for Indigenous children. The Longitudinal Study of Indigenous Children is an ongoing cohort study of up to 1,759 children across Australia. We used a multilevel model to examine the association between children's birthweight and BMI z-score in 2011, at age 3-9 years, adjusted for sociodemographic and maternal factors. Complete data were available for 682 of the 1,264 children participating in the 2011 survey; we repeated the analyses in the full sample with BMI recorded (n=1,152) after multilevel multiple imputation. One in ten children were born large for gestational age, and 17% were born small for gestational age. Increasing birthweight predicted increasing BMI; a 1-unit increase in birthweight z-score was associated with a 0.22-unit (95% CI:0.13, 0.31) increase in childhood BMI z-score. Maternal smoking during pregnancy was associated with a significant increase (0.25; 95% CI:0.05, 0.45) in BMI z-score. The multiple imputation analysis indicated that our findings were not distorted by biases in the missing data. High birthweight may be a risk indicator for overweight and obesity among Indigenous children. National targets to reduce the incidence of low birthweight which measure progress by an increase in the population's average birthweight may be ignoring a significant health risk; both ends of the spectrum must be considered. Interventions to improve maternal health during pregnancy are the first step to decreasing the prevalence of high BMI among the next generation of Indigenous children.
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Affiliation(s)
- Katherine A. Thurber
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Timothy Dobbins
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Phyll Dance
- ANU Medical School, The Australian National University, Canberra, Australia
- National Centre for Indigenous Studies, The Australian National University, Canberra, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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Passey ME, Sanson-Fisher RW. Response to Gould et al's Letter to the Editor: Provision of Antenatal Smoking Cessation Support: A Survey With Pregnant Aboriginal and Torres Strait Islander Women. Nicotine Tob Res 2015; 18:106-7. [PMID: 25895949 DOI: 10.1093/ntr/ntv086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Megan E Passey
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, Australia;
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Small S, Porr C, Swab M, Murray C. The experience and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence protocol. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513040-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Passey ME, Sanson-Fisher RW. Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women. Nicotine Tob Res 2015; 17:746-9. [PMID: 25634937 PMCID: PMC4425935 DOI: 10.1093/ntr/ntv019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Guidelines recommend assessment of smoking status, with advice and support for smoking cessation, as a routine and integral part of antenatal care. Approximately 50% of pregnant Australian Aboriginal and Torres Strait Islander women smoke through pregnancy, 3 times the rate of other pregnant Australian women. This study describes smoking cessation assessment and support reported by pregnant Aboriginal and Torres Strait Islander women. METHODS Surveys of 261 pregnant Aboriginal and Torres Strait Islander women in New South Wales and the Northern Territory, Australia assessed women's reports of assessment, advice and support for smoking cessation from antenatal providers. RESULTS The majority of women (90%, 95% CI = 85, 93) reported being asked their smoking status; 81% (95% CI = 73, 87) of smokers reported being advised to stop smoking and 62% (95% CI = 53, 71) of smokers reported being offered support to quit. CONCLUSIONS Despite most pregnant women who smoke reporting advice and support to quit, the persisting high prevalence of smoking suggests that this support is insufficient to overcome the many factors pushing women to smoke. Improving the support provided to women will require empowering the antenatal providers with adequate skills, appropriate resources and effective interventions. Current guidelines are based on research from non-Indigenous populations, as there are no published effective interventions for Indigenous pregnant women. Trials of interventions designed specifically for pregnant Aboriginal and Torres Strait Islander women are urgently needed, as are approaches aimed at reducing uptake of smoking.
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Affiliation(s)
- Megan E Passey
- University Centre for Rural Health-North Coast, School of Public Health, University of Sydney, Lismore, Australia;
| | - Robert W Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, Australia
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Passey ME, Sanson-Fisher RW, Stirling JM. Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and pregnant indigenous women. Matern Child Health J 2014; 18:2293-9. [PMID: 24150690 PMCID: PMC4220103 DOI: 10.1007/s10995-013-1373-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.
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Glover M, Kira A, Walker N, Bauld L. Using Incentives to Encourage Smoking Abstinence Among Pregnant Indigenous Women? A Feasibility Study. Matern Child Health J 2014; 19:1393-9. [DOI: 10.1007/s10995-014-1645-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greaves L, Hemsing N, Poole N, Bialystok L, O’Leary R. From fetal health to women’s health: expanding the gaze on intervening on smoking during pregnancy. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.968527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wicklow BA, Sellers EAC. Maternal health issues and cardio-metabolic outcomes in the offspring: a focus on Indigenous populations. Best Pract Res Clin Obstet Gynaecol 2014; 29:43-53. [PMID: 25238683 DOI: 10.1016/j.bpobgyn.2014.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/13/2014] [Indexed: 01/28/2023]
Abstract
Non-communicable diseases (NCDs) including diabetes, obesity and cardiovascular disease are the leading causes of death worldwide. Indigenous populations are disproportionally affected. In an effort to halt the increasing disease burden, the mechanisms underlying the increasing rate of NCDs are an important area of study. Recent evidence has focused on the perinatal period as an influential period impacting the future cardio-metabolic health of the offspring. This concept has been defined as metabolic foetal programming and supports the importance of the developmental origins of health and disease in research and clinical practice, specifically in prevention efforts to protect future generations from NCDs. An understanding of the underlying mechanisms involved is not clear as of yet. However, an understanding of these mechanisms is imperative in order to plan effective intervention strategies. As much of the discussion below is gleaned from large epidemiological studies and animal studies, further research with prospective cohorts is necessary.
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Affiliation(s)
- Brandy A Wicklow
- Department of Paediatric and Child Health, University of Manitoba, FE- 307 685 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
| | - Elizabeth A C Sellers
- Department of Paediatric and Child Health, University of Manitoba, FE- 307 685 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
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Jongen C, McCalman J, Bainbridge R, Tsey K. Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings. BMC Pregnancy Childbirth 2014; 14:251. [PMID: 25073873 PMCID: PMC4261787 DOI: 10.1186/1471-2393-14-251] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background Persistent disparities in pregnancy and birth outcomes between Aboriginal and Torres Strait Islander and other Australians evidence a need to prioritise responsive practice in Maternal Child Health (MCH). This study reviewed the existing knowledge output on Aboriginal and Torres Strait Islander MCH programs and services with the objective to advance understanding of the current evidence base and inform MCH service development, including the identification of new research priorities. Methods A systematic search of the electronic databases Informit, Proquest, PubMed, Scopus, Wiley, and Cinahl, and 9 relevant websites was undertaken for the period 1993–2012. The reference lists of MCH program reviews were hand-searched for additional relevant studies which met the eligibility criteria. The study designs of included publications were classified and the characteristics extracted and categorized. Evaluation quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Program (CASP) tool for qualitative studies. Results Twenty-three search results were identified for inclusion, with the majority published in 2003–2012. Fifty two percent of publications reported on programs and services operating out of Aboriginal Community Controlled Health Organisations, with antenatal and postnatal care the main intervention type/s, and health promotion/education and advice/support the most common intervention component. Outcomes such as increased antenatal attendance and higher infant birth weights were reported in some intervention studies, however methodological quality varied considerably with quantitative studies typically rated weak. Conclusion The prevalence of community controlled and/or community-based programs is significant given the health and wellbeing implications of self-determination. While the literature highlights the promise of many intervention models and program components used there are some significant gaps in the documentation and implementation of important MCH interventions. Similarly, while positive health outcomes were reported there are issues with key measures used and study quality. This review highlights the need to improve the quality of evaluations of MCH programs for Aboriginal and Torres Strait Islander women and to address the key evidence gaps in responding to their health and wellbeing needs.
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Affiliation(s)
| | - Janya McCalman
- The Cairns Institute, James Cook University, PO Box 6811, Cairns QLD 4870, Australia.
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