Aboriginal and Torres Strait Islander women: an examination of smoking during pregnancy

After decades of discrimination and deprivation, Australia’s Aboriginal and Torres Strait Islander population faces social circumstances and health status which resemble that of a third world population group. With a wide range of health risk factors and morbidities among this population, a logical place to begin tackling the health problems is at the beginning of life. With increasing recognition of the influence of the intrauterine environment upon health, not only during infancy but into adulthood, improving health during pregnancy offers substantial benefit for present and future generations. The poor health of Aboriginal and Torres Strait Islander Australians is deeply ingrained in social deprivation, poor mental well-being, and an array of modifiable risk factors. Smoking is one risk factor at the centre of this complex web. Smoking is often accompanied by, or used as relief in, stressful situations associated with socioeconomic status, mental health, illness, and other addictions. In order to determine the most appropriate way to tackle the smoking issue among Aboriginal and Torres Strait Islander women, a series of studies were conducted. Initial literature reviews found limited evidence derived from methodologically rigorous studies in mainstream populations, and even less evidence for Aboriginal and Torres Strait Islander, or other Indigenous groups. Exploration of the knowledge and attitudes of these women in relation to antenatal smoking was conducted to identify the most appropriate targets for intervention. The findings from extensive background studies were drawn upon to design an intervention which aimed to be culturally appropriate for Aboriginal and Torres Strait Islander women, providing intensive support to assist these women to quit smoking during their pregnancy. Pilot data from the resulting intervention is presented in Chapter 8 of this Thesis. The social network among Aboriginal and Torres Strait Islander communities appears to play a central role in the behaviour of individuals. With an array of risk factors and influences found not only in the individuals surrounding women, but in their socioeconomic circumstances and overall environment, it may be that the most important approach for achieving health and behaviour change among this population is the mobilisation of social support and efforts to intervene with multiple elements of that environment.