Supporting Pregnant Aboriginal and Torres Strait I

Authors: Megan E Passey Rob W SansonFisher Janelle M Stirling

Publish Date: 2013/10/23

Volume: 18, Issue: 10, Pages: 2293-2299

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Abstract

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers Crosssectional 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 womenTobacco smoking among pregnant Aboriginal and Torres Strait Islander women remains three times as common as among nonIndigenous Australian pregnant women with approximately 50  of women smoking during pregnancy 1 Addressing this disparity is a priority for reducing the gap in health outcomes between Indigenous and nonIndigenous Australians Disparities in smoking rates between Indigenous and nonIndigenous pregnant women are also marked in the United States Canada and New Zealand 2 3 4 While interventions to reduce antenatal smoking are known to be effective in nonIndigenous populations 5 to date effective interventions for pregnant Indigenous women have not been identified 6 7 8Previous reviews of interventions for smoking cessation in Indigenous peoples have concluded that approaches that specifically target Indigenous populations can be successful 9 10 and that interventions targeting individuals such as counselling and nicotine replacement therapy NRT which are known to be effective in other populations are likely to be effective for Indigenous people 11 However these reviews did not include trials with pregnant Indigenous women A review of smoking cessation interventions specifically for pregnant Indigenous women identified only two relevant trials neither of which increased cessation highlighting the need for further research to identify effective strategies 8 In addition to considering approaches found to work in other pregnant population groups a useful starting point for developing interventions is an exploration of the views of pregnant Indigenous women and the staff providing their antenatal careCrosssectional surveys with antenatal care providers and pregnant Indigenous women were undertaken in the Northern Territory NT and New South Wales NSW The project was guided by a community reference group CRG to ensure cultural security The CRG was composed of Aboriginal women from the community some of whom were pregnant Aboriginal Health Workers AHWs and Community Midwives Ethical approval for the research was provided by the Human Research Ethics Committees of the University of Newcastle the NT Department of Human Services and Menzies School of Health Research Hunter New England Health Service and the Aboriginal Health Medical Research Council of NSWBriefly staff providing antenatal care in remote medical services in the NT and through the Aboriginal Maternal and Infant Health Service AMIHS in NSW were eligible and were identified by their relevant health departments and services All staff worked in community based services Between September 2008 and July 2009 eligible staff were sent invitation letters information sheets and selfcompletion questionnaires They were asked to complete the anonymous questionnaires and return them in prepaid envelopes Reminder letters with additional copies of the documents were sent twice—3 weeks after the initial invitation and again 1 month later Return of the questionnaire was considered to imply consentWomen were recruited by the AMIHS teams from July to December 2009 and from the maternity outpatient clinic of a major hospital from July to September 2010 and April to June 2011 Women were eligible if pregnant and if they or their partner were Indigenous They were excluded if aged less than 16 being treated for mental illness or unable to provide informed consent Consecutive eligible women were invited to participate by the midwife AHW or a female Aboriginal research assistant who explained the study and provided women with information sheets Written consent was obtained Recruiting staff offered assistance to complete the questionnaire if required Staff were asked to invite all eligible women to participate and to complete a recruitment log to track participation rates

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