An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial
ABSTRACT To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks' gestation among pregnant Aboriginal and Torres Strait Islander women.
Randomised controlled trial.Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009.
A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman's partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control ("usual care") group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits.
Self-reported smoking status (validated with a urine cotinine measurement) between 36 weeks' gestation and delivery.
Participants in the intervention group (n = 148) and usual care group (n = 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86-1.08]; P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis.
An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result.
Australian New Zealand Clinical Trials Registry ACTRN12609000929202.
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ABSTRACT: Guidelines recommend assessment of smoking status, with advice and support for smoking cessation, as a routine and integral part of antenatal care. Approximately 50% of pregnant Australian Aboriginal and Torres Strait Islander women smoke through pregnancy, three times the rate of other pregnant Australian women. This study describes smoking cessation assessment and support reported by pregnant Aboriginal and Torres Strait Islander women. Surveys of 261 pregnant Aboriginal and Torres Strait Islander women in New South Wales and the Northern Territory, Australia assessed women's reports of assessment, advice and support for smoking cessation from antenatal providers. The majority of women (90%, 95%CI: 85%, 93%) reported being asked their smoking status; 81% (95%CI: 73%, 87%) of smokers reported being advised to stop smoking and 62% (95%CI: 53%, 71%) of smokers reported being offered support to quit. Despite most pregnant women who smoke reporting advice and support to quit, the persisting high prevalence of smoking suggests that this support is insufficient to overcome the many factors pushing women to smoke. Improving the support provided to women will require empowering the antenatal providers with adequate skills, appropriate resources and effective interventions. Current guidelines are based on research from non-Indigenous populations, as there are no published effective interventions for Indigenous pregnant women. Trials of interventions designed specifically for pregnant Aboriginal and Torres Strait Islander women are urgently needed, as are approaches aimed at reducing uptake of smoking. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.Nicotine & Tobacco Research 01/2015; 17(6). DOI:10.1093/ntr/ntv019 · 2.81 Impact Factor
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ABSTRACT: Background: Smoking during pregnancy causes obstetric and fetal complications, and smoking cessation may have great benefits for the mother and the child. However, some pregnant women continue smoking even in pregnancy. Objective: To review the literature addressing the prevalence of smoking during pregnancy, explore psychosocial factors associated with smoking, and review the evidence of psychosocial interventions for smoking cessation during pregnancy in recent years. Literature review: Computerized Internet search results in PubMed for the years spanning from 2004 to 2014, as well as references cited in articles, were reviewed. A search for the keywords “smoking cessation pregnancy” and “intervention” and “clinical trials” yielded 52 citations. Thirty-five citations were identified as useful to this review for the evidence of psychosocial interventions for smoking cessation during pregnancy. Results: The prevalence of smoking during pregnancy differs by country, reflecting the countries’ social, cultural, and ethnic backgrounds. Women who had socioeconomic disadvantages, problems in their interpersonal relationships, higher stress, depression, less social support, and who engaged in health-risk behaviors were more prone to smoking during pregnancy. Psychosocial interventions, such as counseling, are effective methods for increasing smoking cessation. Conclusion: Smokers may have various psychosocial problems in addition to health problems. It is important to understand each individual’s social situation or psychosocial characteristics, and a psychosocial intervention focused on the characteristics of the individual is required.International Journal of Women's Health 04/2015; 7:415-427. DOI:10.2147/IJWH.S54599
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ABSTRACT: Aboriginal and Torres Strait Islander families experience markedly worse maternal and child health outcomes than non-Aboriginal families. The objective of this study was to investigate the experiences of women attending Aboriginal Family Birthing Program services in South Australia compared with women attending mainstream public antenatal care. Population-based survey of mothers of Aboriginal babies giving birth in urban, regional, and remote areas of South Australia between July 2011 and June 2013. A total of 344 women took part in the study around 4-9 months after giving birth; 93 percent were Aboriginal and/or Torres Strait Islanders, and 7 percent were non-Aboriginal mothers of Aboriginal babies. Of these, 39 percent of women lived in a major city, 36 percent in inner or outer regional areas, and 25 percent in remote areas of South Australia. Compared with women attending mainstream public antenatal care, women attending metropolitan and regional Aboriginal Family Birthing Program services had a higher likelihood of reporting positive experiences of pregnancy care (adjOR 3.4 [95% CI 1.6-7.0] and adjOR 2.4 [95% CI 1.4-4.3], respectively). Women attending Aboriginal Health Services were also more likely to report positive experiences of care (adjOR 3.5 [95% CI 1.3-9.4]). In the urban, regional, and remote areas where the Aboriginal Family Birthing Program has been implemented, the program has expanded access to culturally responsive antenatal care for Aboriginal women and families. The positive experiences reported by many women using the program have the potential to translate into improved outcomes for Aboriginal families. © 2015 Wiley Periodicals, Inc.Birth 01/2015; 42(1). DOI:10.1111/birt.12143 · 2.05 Impact Factor