Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Getting over the shock: taking action on Indigenous maternal smoking

Gillian S. Gould A D , Yvonne Cadet-James B and Alan R. Clough C
+ Author Affiliations
- Author Affiliations

A Centre for Brain and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.

B Australian Aboriginal and Torres Strait Islander Centre, James Cook University, Townsville, Qld 4811, Australia.

C Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Qld 4870, Australia.

D Corresponding author. Email: gillian.gould@newcastle.edu.au

Australian Journal of Primary Health 22(4) 276-282 https://doi.org/10.1071/PY15066
Submitted: 10 March 2015  Accepted: 21 February 2016   Published: 21 July 2016

Journal Compilation © La Trobe University 2016

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.


References

Australian Bureau of Statistics (2014) 4727.0.55.006 – Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. (Australian Bureau of Statistics: Canberra)

Australian Government (2011) Indigenous anti-smoking campaign: break the chain – quantitative Campaign effectiveness: research – executive summary. Available at http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/Content/btc-indsurvey-execsumm [Verified 15 November 2014]

Australian Government (2012) National tobacco campaign: more targeted approach– 2012–2013. Available at http://quitnow.gov.au/internet/quitnow/publishing.nsf/Content/mta [Verified 7 July 2016]

Aveyard P, Begh R, Parsons A, West R (2012) Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction 107, 1066–1073.
Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance.Crossref | GoogleScholarGoogle Scholar | 22175545PubMed |

Berlin I, Grange G, Jacob N, Tanguy ML (2014) Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy. British Medical Journal 348, g1622
Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy.Crossref | GoogleScholarGoogle Scholar | 24627552PubMed |

Brose LS, McEwen A, West R (2013) Association between nicotine replacement therapy use in pregnancy and smoking cessation. Drug and Alcohol Dependence 132, 660–664.
Association between nicotine replacement therapy use in pregnancy and smoking cessation.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXns1Khs78%3D&md5=cba4014ac3e93fb7d24a65209066e65dCAS | 23680076PubMed |

Cancer Council Queensland (2014) Shock over Indigenous pregnancy smoking rates. Available at http://www.cancerqld.org.au/page/news/newsroom_2014/shock_over_indigenous_pregnancy_smoking_rates/ [Verified 28 December 2014]

Carson KV, Brinn MP, Peters M, Veale A, Esterman AJ, Smith BJ (2012a) Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012, CD009046

Carson KV, Verbiest MEA, Crone MR, Brinn MP, Esterman AJ, Assendelft WJ, Smith BJ (2012b) Training health professionals in smoking cessation. Cochrane Database of Systematic Reviews 2012, CD000214

Chamberlain C, O’Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J (2013) Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2013, CD001055

Coleman T, Cooper S, Thornton JG, Grainge MJ, Watts K, Britton J, Lewis S, Smoking, Nicotine and Pregnancy (SNAP) Trial Team (2012) A Randomized trial of nicotine-replacement therapy patches in pregnancy. The New England Journal of Medicine 366, 808–818.
A Randomized trial of nicotine-replacement therapy patches in pregnancy.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XjsV2qurk%3D&md5=5277fdaff66d9cffd7c17ac866d1062cCAS | 22375972PubMed |

Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J (2015) Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2015, CD010078

Dempsey D, Jacob P, Benowitz NL (2002) Accelerated metabolism of nicotine and cotinine in pregnant smokers. The Journal of Pharmacology and Experimental Therapeutics 301, 594–598.
Accelerated metabolism of nicotine and cotinine in pregnant smokers.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38XjtlKisr0%3D&md5=ca5ea7e5ce53e16467a134abbba7632fCAS | 11961061PubMed |

Gould GS (2014) Exploring the barriers and enablers to smoking cessation in pregnant Aboriginal and Torres Strait Islander women with the behaviour change wheel. Australasian Epidemiologist 21, 31–35.

Gould GS, McEwen A, Watters T, Clough AR, van der Zwan R (2013a) Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis. Tobacco Control 22, e7
Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis.Crossref | GoogleScholarGoogle Scholar | 22918939PubMed |

Gould GS, Munn J, Watters T, McEwen A, Clough AR (2013b) Knowledge and views about maternal tobacco smoking and barriers for cessation in Aboriginal and Torres Strait Islanders: a systematic review and meta-ethnography. Nicotine & Tobacco Research 15, 863–874.
Knowledge and views about maternal tobacco smoking and barriers for cessation in Aboriginal and Torres Strait Islanders: a systematic review and meta-ethnography.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXmt1Snu7k%3D&md5=adb87c3b9eb34e30469e2dde8930777dCAS |

Gould GS, Munn J, Avuri S, Hoff S, Cadet-James Y, McEwen A, Clough AR (2013c) ‘Nobody smokes in the house if there’s a new baby in it’: Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia. Women and Birth; Journal of the Australian College of Midwives 26, 246–253.
‘Nobody smokes in the house if there’s a new baby in it’: Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia.Crossref | GoogleScholarGoogle Scholar | 24011470PubMed |

Gould GS, Watt K, Stevenson L, McEwen A, Cadet-James Y, Clough AR (2014) Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey. BMC Public Health 14, 250
Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey.Crossref | GoogleScholarGoogle Scholar | 24625235PubMed |

Gould GS, Bittoun R, Clarke MJ (2015a) A pragmatic guide for smoking cessation counselling and the initiation of nicotine replacement therapy for pregnant Aboriginal and Torres Strait Islander smokers. Journal of Smoking Cessation 10, 96–106.
A pragmatic guide for smoking cessation counselling and the initiation of nicotine replacement therapy for pregnant Aboriginal and Torres Strait Islander smokers.Crossref | GoogleScholarGoogle Scholar |

Gould GS, Bittoun R, Clarke M (2015b) Guidance for culturally competent approaches to smoking cessation for Aboriginal and Torres Strait Islander pregnant women – letter to the Editor. Nicotine & Tobacco Research 18, 104–105.

Gould GS, Watt K, McEwen A, Cadet-James Y, Clough AR (2015c) Predictors of intentions to quit smoking in Aboriginal tobacco smokers of reproductive age in regional New South Wales (NSW), Australia: quantitative and qualitative findings of a cross-sectional survey. BMJ Open 5, e007020
Predictors of intentions to quit smoking in Aboriginal tobacco smokers of reproductive age in regional New South Wales (NSW), Australia: quantitative and qualitative findings of a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar | 25770232PubMed |

Gould GS, Watt K, Cadet-James Y, Clough AR (2015d) Using the risk behaviour diagnosis scale to understand Australian Aboriginal smoking – a cross-sectional validation survey in regional New South Wales. Preventive Medicine Reports 2, 4–9.
Using the risk behaviour diagnosis scale to understand Australian Aboriginal smoking – a cross-sectional validation survey in regional New South Wales.Crossref | GoogleScholarGoogle Scholar | 26844043PubMed |

Gould GS, Bonevski B, Watt K, Clarke M, Atkins L, Cadet-James Y (2015e) How are Australian general practitioners assisting pregnant women to quit? In ‘Oceania Tobacco Control Conference’, 20–22 October 2015, Perth, WA. p. 38. (Cancer Council WA)

Graham H, Flemming K, Fox D, Heirs M, Sowden A (2014) Cutting down: insights from qualitative studies of smoking in pregnancy. Health & Social Care in the Community 22, 259–267.
Cutting down: insights from qualitative studies of smoking in pregnancy.Crossref | GoogleScholarGoogle Scholar |

Herbert R, Coleman T, Britton J (2005) UK general practitioners’ beliefs, attitudes, and reported prescribing of nicotine replacement therapy in pregnancy. Nicotine & Tobacco Research 7, 541–546.
UK general practitioners’ beliefs, attitudes, and reported prescribing of nicotine replacement therapy in pregnancy.Crossref | GoogleScholarGoogle Scholar |

Li Z, Zeki R, Hilder L, Sullivan EA (2012). Australia’s mothers and babies 2010. (Australian Institute of Health and Welfare (AIHW) National Perinatal Epidemiology and Statistics Unit: Canberra)

Market Equity (2000). The forgotten smokers. Indigenous smoking: issues and responses. (Australian Medical Association and Australian Pharmaceutical Manufacturers Association)

McBride CM, Emmons KM, Lipkus IM (2003) Understanding the potential of teachable moments: the case of smoking cessation. Health Education Research 18, 156–170.
Understanding the potential of teachable moments: the case of smoking cessation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s3gsl2msQ%3D%3D&md5=427b1b2f733abafe5c74e58648cf9fb6CAS | 12729175PubMed |

Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 6, 1–11.

Murphy M, Mee V (1999) Australia’s National Tobacco Campaign: evaluation report, volume 1. Chapter 6. The impact of the National Tobacco Campaign on Indigenous communities. (Department of Health and Ageing: Canberra)

Naughton F, Eborall H, Sutton S (2013) Dissonance and disengagement in pregnant smokers: a qualitative study. Journal of Smoking Cessation 8, 24–32.
Dissonance and disengagement in pregnant smokers: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

Nicholson AK, Borland R, Sarin J, Wallace S, van der Sterren AE, Stevens M, Thomas DP (2015a) Recall of anti-tobacco advertising and information, warning labels and news stories in a national sample of Aboriginal and Torres Strait Islander smokers. The Medical Journal of Australia 202, 67–72.
Recall of anti-tobacco advertising and information, warning labels and news stories in a national sample of Aboriginal and Torres Strait Islander smokers.Crossref | GoogleScholarGoogle Scholar |

Nicholson AK, Borland R, Davey ME, Stevens M, Thomas DP (2015b) Predictors of wanting to quit in a national sample of Aboriginal and Torres Strait Islander smokers. The Medical Journal of Australia 202, 26–32.
Predictors of wanting to quit in a national sample of Aboriginal and Torres Strait Islander smokers.Crossref | GoogleScholarGoogle Scholar |

NSW Department of Health (2014) NSW Tobacco Snapshot – May 2014. Available at http://www.health.nsw.gov.au/tobacco/pages/default.aspx [Verified 27 September 2014]

Passey M, Sanson-Fisher RW (2015) Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women. Nicotine & Tobacco Research 17, 746–749.
Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women.Crossref | GoogleScholarGoogle Scholar |

Passey M, Gale J, Sanson-Fisher R (2011) ‘It’s almost expected’: rural Australian Aboriginal women’s reflections on smoking initiation and maintenance: a qualitative study. BMC Women’s Health 11, 1–12.

Passey M, D’Este CA, Stirling JM, Sanson-Fisher RW (2012a) Factors associated with antenatal smoking among Aboriginal and Torres Strait Islander women in two jurisdictions. Drug and Alcohol Review 31, 608–616.
Factors associated with antenatal smoking among Aboriginal and Torres Strait Islander women in two jurisdictions.Crossref | GoogleScholarGoogle Scholar | 22487020PubMed |

Passey M, D’Este CA, Sanson-Fisher R (2012b) Knowledge, attitudes and other factors associated with assessment of tobacco smoking among pregnant Aboriginal women by health care providers: a cross-sectional survey. BMC Public Health 12, 165
Knowledge, attitudes and other factors associated with assessment of tobacco smoking among pregnant Aboriginal women by health care providers: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar | 22397580PubMed |

Passey ME, Bryant J, Hall AE, Sanson-Fisher RW (2013) How will we close in smoking rates for pregnant Indigenous women. The Medical Journal of Australia 199, 39–41.
How will we close in smoking rates for pregnant Indigenous women.Crossref | GoogleScholarGoogle Scholar | 23829261PubMed |

Pollak KI, Oncken CA, Lipkus IM, Lyna P, Swamy GK, Pletsch PK, Peterson BL, Heine RP, Brouwer RJ, Fish L, Myers ER (2007) Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. American Journal of Preventive Medicine 33, 297–305.
Nicotine replacement and behavioral therapy for smoking cessation in pregnancy.Crossref | GoogleScholarGoogle Scholar | 17888856PubMed |

Thomas D (2012) National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994–2008. Australian and New Zealand Journal of Public Health 36, 24–29.
National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994–2008.Crossref | GoogleScholarGoogle Scholar | 22313702PubMed |

Walker N, Johnston V, Glover M, Bullen C, Trenholme A, Chang A, Morris P, Segan C, Brown N, Fenton D, Hawthorne E, Borland R, Parag V, Von Blaramberg T, Westphal D, Thomas D (2015) Effect of a family-centered, secondhand smoke intervention to reduce respiratory illness in Indigenous infants in Australia and New Zealand: a randomized controlled trial. Nicotine & Tobacco Research 17, 48–57.
Effect of a family-centered, secondhand smoke intervention to reduce respiratory illness in Indigenous infants in Australia and New Zealand: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |

Zwar N, Richmond R, Borland R, Peters M, Litt J, Bell J, Caldwell B, Ferretter I (2014) Supporting smoking cessation: a guide for health professionals. (The Royal Australian College of General Practitioners: Melbourne) Available at http://www.racgp.org.au/your-practice/guidelines/smoking-cessation/ [Verified 15 June 2016]