A mixed methods exploratory study tackling smoking during pregnancy in an urban Aboriginal and Torres Strait Islander primary health care service

Deborah A Askew,Sonya Egert,Lynne Rogers,Philip J Schluter,Jillian Guy,Peggy Manton-Williams,Leigh-Anne Pokino,Vivian Lyall

doi:10.1186/s12889-019-6660-1

Abstract

BackgroundPregnancy can be a time of joy and a time of significant stress. For many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress. Indigenous women smoke during pregnancy at higher rates than their non-Indigenous counterparts.MethodsA mixed methods, exploratory study, undertaken in an urban, Indigenous primary health care service, tested the impact and acceptability of a smoking cessation intervention for women pregnant with an Indigenous baby, their significant other (SO), and their primary health care service. The intervention included case management, incentivised smoking cessation support and culturally-based art activities.ResultsThirty-one pregnant women and 16 SOs participated. Nearly half attempted to quit at least once during the study, 36% (4/11) of pregnant women had quit at the 3 month assessment and two remained smoke free 1 month postpartum. Most participants self-reported a reduction in tobacco smoking. Exhaled CO confirmed this for SOs (mean reduction − 2.2 ppm/assessment wave, 95% CI: -4.0, − 0.4 ppm/assessment wave, p = 0.015) but not for pregnant women. Many participants experienced social and economic vulnerabilities, including housing and financial insecurity and physical safety concerns.ConclusionsTobacco smoking is normalised and socially sanctioned in Indigenous communities and smoking is frequently a response to the multitude of stressors and challenges that Indigenous people experience on a daily basis. Smoking cessation interventions for pregnant Indigenous women must be cognisant of the realities of their private lives where the smoking occurs, in addition to the impact of the broader societal context. Narrow definitions of success focussing only on smoking cessation ignore the psychological benefit of empowering women and facilitating positive changes in smoking behaviours. Our smoking cessation intervention supported pregnant women and their SOs to manage these stressors and challenges, thereby enabling them to develop a solid foundation from which they could address their smoking. A broad definition of success in this space is required: one that celebrates positive smoking behaviour changes in addition to cessation.

Highlights

IntroductionFor many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress
Pregnancy can be a time of joy and a time of significant stress
The Empowering Strong Families 4077 (ESF) smoking cessation intervention was predicated on the understanding that the high rates of smoking among Indigenous people are a sequela of their differential access to power and resources, and their lived experiences of racism, oppression and poverty

Summary

Introduction

For many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress. The focus on individuals’ behaviours risks stigmatising women who smoke during pregnancy as non-caring, non-compliant, and dysfunctional [8]. It fails to acknowledge the normalisation of smoking in Indigenous communities and the concomitant role of smoking in the maintenance of social networks and affirmation of cultural identity [5, 8, 9]. It ignores the inextricable link between Indigenous people’s use of tobacco and Australia’s history of colonisation [10]

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Conclusion