Chronological narratives from smoking initiation through to pregnancy of Indigenous Australian women: A qualitative study

Abstract

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.

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

“…32,37 Women who have smoked during pregnancy have reported that coming of age as a smoker, being able to purchase one's own supplies legally, and exposure to alcohol accelerated tobacco dependence. 36 Concurrent alcohol use and smoking initiation as well as earlier uptake of smoking are independent predictors of reduced intentions to stop smoking in Australian Indigenous men and women of reproductive age. 38 High tar and nicotine brands were marketed to Indigenous populations using Aboriginal images as recently as 1998.…”

“…Mothers are particularly influential for young women. [32][33][34][35][36] Adolescent Indigenous girls may be more influenced by social networks and peer pressure than are boys. 32,37 Women who have smoked during pregnancy have reported that coming of age as a smoker, being able to purchase one's own supplies legally, and exposure to alcohol accelerated tobacco dependence.…”

“…52 Protective influences for abstinence in Indigenous smokers can be positive role models of family members and elders. 36 It is uncertain whether strategies to reduce smoking initiation among Indigenous youth would translate into reduced tobacco smoking among Indigenous women during pregnancy. There is some evidence from a Cochrane review 53 to support the effectiveness of school and community interventions in reducing the uptake of smoking in young people in the general population.…”

“…Australian Aboriginal women who have told their stories about the trajectory of smoking from initiation through successive pregnancies illustrated many salient moments when smoking could be addressed. 36 Pregnancy is a teachable moment, and on becoming pregnant, Aboriginal women report a shift in role and risk perception about smoking and an urge to protect their babies. 31 However, women also report inconsistent approaches and advice offered to them by health professionals, sometimes being told to reduce rather than stop smoking and seldom being offered pharmacologic treatment.…”

“…102 Indigenous Australian women report stressful life circumstances and depression as reasons to resume smoking postpartum. 36 Self-help booklets have been found to prevent relapse in the general pregnant population. 103 There is very little known about what strategies would help Indigenous pregnant women stay abstinent after birth, as thus far so few are stopping smoking during pregnancy, and relapse has not been examined during trials to date.…”