Factors Affecting Smoking Cessation in Pregnant Indigenous Women in Australia

This article discusses the factors that impede or facilitate smoking cessation in pregnant indigenous women in Australia. It covers the effects of smoking during pregnancy, the benefits of smoking cessation, and a systematic review of published academic sources on the topic. The article also includes a PICO table, study limitations, and ethical considerations.

Running Header: SMOKING CESSATION IN PREGNANCY 1
FACTORS THAT IMPEDE OR FACILITATE SMOKING CESSATION IN PREGNANT
WOMEN IN THE INDIGENOUS COMMUNITY OF AUSTRALIA.
Student Name
Institutional affiliation
Course name
Date.

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INTRODUCTION
World Health Organization (WHO), has termed tobacco use to be a global epidemic as it has a
high prevalence and has continued to be used worldwide. Smoking is of particular concern
among the indigenous community although all that is known, is known through reports obtained
from Australia, New Zealand, Canada and United Kingdom. It has been noted that in these
countries the indigenous people smoking rate is twice or higher than the general community.
According to the Substance Abuse and Mental Health Services Administration, (2012) sixteen
percent (16%) of pregnant women have a smoking habit.
In Australia the smoking rates are very low, although the Aboriginal people are likely to smoke
three to more times than the non-Aboriginal community. In pregnancy this gets worse as 48% of
Aboriginal women smoke as compared to the 13% of the non-Aboriginals. Among the
adolescent population the Aboriginals are likely to smoke three to four times more than the non-
Aboriginals.
Smoking during the pregnancy phase raises an alarm as not only does it affect the general health
of the pregnant woman, it has adverse effects on the outcomes of the pregnancy, the fetus health,
child’s health to adulthood years (Oken et al., 2008; Syme et al., 2010; Power et al., 2010). The
fatal consequences include; placental abruption, placental Previa, premature delivery, low birth
weight during pregnancy and cleft plate and cleft lip and lung function impairment at birth. In
addition to this, the behavioral disorders during childhood and the genital abnormalities have
been traced back to smoking during pregnancy (obesity and overweight, attention deficit
hyperactivity, risks of metabolic disorders and cardiovascular illness.

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In addition to these, it has effects on DNA methylation (DNAm) modulation. DNAm has a major
function in regulation of the gene expression and the genomic architecture (Tsukahra et al. 2009;
Levin and Moran 2011). Cigarettes smoke has been found to be having carcinogens, carbon
monoxide, and nicotine in large quantities which modifies the DNAm altering cell division and
differentiation Di et al., 2012). These chemicals are easily passed to the unborn child via the
placenta (Joubert et al., 2012). It has also been found out that DNAm persists even after birth
causing genetic abnormalities.
Lastly, women who smoke during pregnancy continues with this habit during the postpartum
period. This exposes the newborn to nicotine during breastfeeding. Breast milk is the one
nutrition for newborn although these women who smoke tend to stop breastfeeding earlier than
the non-smoking mothers. This denies these children the nutritional value of the breast milk. For
the few who still breastfeed and smoke, they expose the newborns to the effects of secondhand
smoking.
RESEARCH QUESTION
‘The factors that impede or facilitate Smoking cessation in Pregnant women in the
Indigenous Community of Australia (Tasmania).’
Smoking is of particular concern among the indigenous community although all that is known, is
known through reports obtained from Australia, New Zealand, Canada and United Kingdom. It
has been noted that in these countries the indigenous people smoking rate is twice or higher than
the general community. According to the Substance Abuse and Mental Health Services
Administration, (2012) sixteen percent of pregnant women have a smoking habit. Smoking
during the pregnancy phase raises an alarm as not only does it affect the general health of the

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pregnant woman, it has adverse effects on the outcomes of the pregnancy, the fetus health,
child’s health to adulthood years (Oken et al., 2008; Syme et al., 2010; Power et al., 2010). The
fatal consequences include; placental abruption, placental Previa, premature delivery, low birth
weight during pregnancy and cleft plate and cleft lip and lung function impairment at birth. In
addition to this, the behavioral disorders during childhood and the genital abnormalities have
been traced back to smoking during pregnancy.
RESEARCH METHODOLOGY.
Methods: A systematic review on published academic sources using standardized keywords
(pregnancy smoking, effects of smoking, complications in pregnancy) on the following
databases; Medline, Cochrane library, Clinical government trials, CINAHL, and the Web of
Science) to find out the effects of smoking during pregnancy in the indigenous community. The
Critical Appraisal Checklist for Qualitative Research (CASP) was used so as to analyze the data
obtained and determine its validity and reliability to the research question. Are the research
questions answered by the sources obtained? Themes were developed at the analysis stage. These
themes led to development of recommendation which are based on PARiHS framework.
Study variables
The validity, reliability and the eligibility of the literature sources was tested using a systematic
approach so as to determine those that best answered the research question. PICO was
formulated so as to make this possible.

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Population Females at childbearing age (Indigenous community).
Intervention Increase the cessation rates of pregnancy smoking among the
indigenous community.
Counter Intervention Socio-economic status, level of knowledge, ethnicity(indigenous
community), culture
Outcome Have a community with reduced pregnancy smoking.
Table 1: PICO.
These table provided the keywords that were used in the specified databases. The sources
obtained were sufficient to conduct the study.
Sampling (The study population)
a) Selecting the Literature and Exclusion/Inclusion Criteria
Inclusion criteria Exclusion criteria
Women Men
Women of childbearing age. Women who are below or above childbearing
age.
Indigenous community. Non-smoking women.
Pregnant women who smoking Articles older than seven years.
The effects of pregnancy smoking.
Literate and illiterate
Low, medium and high income earners.
Worldwide research
All published materials that are relevant

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Articles that are five to seven years old.
Table 2: Inclusion and exclusion criteria.
For an in-depth research and the understanding of the research question, its effectiveness to the
addressed interventions, six sources were chosen so as to be used as randomized control trials.
They were chosen using the traditional hierarchy of evidence (Greenhalgh, 1997: Guyatt, et al.,
1995).
b) Outcome Consideration for Inclusion
No Consideration
1 Effects of smoking during pregnancy.
2 Effects of smoking during pregnancy in the indigenous community.
3 Factors influencing Smoking among the indigenous community especially pregnant
women.
4 Benefits of smoking cessation during pregnancy.
Table 3
c) Data collection and analysis.
Critically Apprising the Literature
45 Articles excluded after
title and abstract screening
200 Non duplicate citations
screened
Clinicaltrialsgov
2007-2017 3 citation
Cochrane
2007-2017 9 citation
MIT libraries 2007-
2017 200 citation
Medline j2007-
2017 101 citation

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Table 4, PRISMA flow diagram (Moher, The PRISMA Group, 2009)
d) Study limitations.
Considering that this study is a systematic review of previous researchers done with the theme of
smoking cessation among the Aboriginals, this makes the data secondary and prone to errors and
biasness.
e) Ethical considerations.
This is a systematic review of peer reviewed literature, therefore there is no contact with people,
the only ethical consideration is by ensuring that the articles used were obtained using the right
channels.
Inclusion/ exclusion criteria
applied
25 Articles Retrieved
Inclusion/ exclusion criteria: 10 articles were excluded
6 Articles included

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CONTENTS
RESULTS
Factors that impede smoking cessation among the Aboriginals:
Socio-economic status.
The Aboriginal’s high rates of smoking among women has been linked to the systematic history
of being marginalized (Greaves et al., 2013). The high difference between the Aboriginals rate of
smoking and the non-Aboriginals has been associated with their low socio-economic status. The
low socio-economic status is associated with the initiation of the smoking habit. The low socio-
economic status is associated with illiteracy, poor child health care and lack of transport cost.
These factors affect their accessibility to the cessation interventions (Brussoni, Olsen, & Joshi,
2012).
Lack of culturally appropriate smoking cessation models.
It is very important to formulate and implement culturally appropriate smoking models as the
ones that ignores the cultural impact and the social context during pregnancy among the
Aboriginals were doomed ineffective (Varcoe et al., 2010). In the Aboriginals community there
are different viewpoints on what health and illnesses constitutes (Loppie Reading & Wien, 2009;
Kendall, 2009) and tobacco holds a lot of value in their native culture as it has greatly been used
in ceremonies and prayers in the Aboriginal community.
Dependency to smoking

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Tobacco dependency has been found to be the major cause of relapses and difficulties to quit
smoking among the pregnant Aboriginal women (Bertollini, Ribeiro, Mauer-Stender, & Galea,
2016).
Stress, mental health disorder and trauma.
There are high rates of mental health disorders, stress and trauma among pregnant Aboriginal
women and their families. This has been associated with their high rates of smoking. The stress
is highly contributed by lack of family support during pregnancy, social stresses for example
financial problems and the relationship problems. Most of them uses smoking as a coping
mechanism (Campbell, 2010).
Lack of the social support.
A high percent of the Aboriginal community smokes, this makes it hard for the pregnant woman
to quit smoking. In addition to this, they lack social support while quitting. They lack
mentors/advisors to walk with them as they quit smoking during pregnancy. This decreases the
cessation rates of pregnancy smoking (Small, Porr, Swab, & Murray, 2018).
Factors that facilitate smoking cessation during pregnancy.
Smoking cessations strategies that are women centered.
It has been found out that when the cessation methods are women centered they have been
effective. These strategies focus on the holistic, comprehensive, health of the woman and the
factors that are attributed to the smoking. Not only is the woman taught on the importance of
cessation of smoking to the baby but also to their health (Wyndow, Walker, & Reibel, 2018).
Conclusion

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In summary, the factors that impede smoking cessation of the pregnant indigenous women are;
low socio-economic status, lack of culturally appropriate cessation models, dependency to
tobacco use, stress and lack of social support. Secondly, the factors that facilitates smoking
cessation is having a women centered cessation models. To increase cessation rates the factors
impeding should be dealt with.

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