Factors Affecting Smoking Cessation in Pregnant Indigenous Women in Australia

Running Header: SMOKING CESSATION IN PREGNANCY 1
FACTORS THAT IMPEDE OR FACILITATE SMOKING CESSATION IN PREGNANT
WOMEN IN THE INDIGENOUS COMMUNITY OF AUSTRALIA.
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THE INDIGENOUS COMMUNITY 2
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.

THE INDIGENOUS COMMUNITY 3
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

THE INDIGENOUS COMMUNITY 4
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.