Higher smoking rates among Indigenous pregnant women

Apr 19 2017

Gillian Gould - researcher for Indigenous health and smoking

Researchers have revealed disadvantaged status drives higher smoking among Indigenous pregnant women in Australia, New Zealand, the USA & Canada.

Indigenous women across four high income countries are not getting the help they need to stop smoking when pregnant. A study published today in the international journal Nicotine & Tobacco Research found common large disparities between indigenous pregnant women’s smoking rates and non-Indigenous pregnant women in Australia, New Zealand, Canada and the United States of America. 

“Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies,” said study lead Associate Professor Gillian Gould of the School of Medicine and Public Health at The University of Newcastle, Australia. “In each of our countries and in Canada, Indigenous pregnant women have smoking rates that are twice to many times higher than the non-Indigenous women.”  

The prevalence of smoking while pregnant varied across states and countries, in Inuit women the prevalence ranged from 18 per cent to 83 per cent. The inequity varied across countries also with Australian Aboriginal maternal smoking at 48 per cent while non-Indigenous Australian women enjoyed a low 13 per cent. 

Co-author Associate Professor Marewa Glover from New Zealand’s Massey University’s School of Public Health said the study was looking for successful intervention ideas they could share. 

“Despite our cultural differences, the Indigenous people in each country experience similar marginalisation and social disadvantage,” she said. “This stems partly from the common way in which we were colonised by Western nation states.” 

“That colonization process resulted in all of us receiving proportionately less of society’s benefits, whether that’s education, healthcare or employment. Our women are disproportionately exposed to environmental risks to health, discrimination and disproportionate incarceration. We are over-represented among the lower paid and unemployed and are more likely to live in deprived areas. The cumulative stress of all this is driving our higher smoking rates and undermining our women’s ability to abstain from smoking, even when they are pregnant.” Glover said.

Professor Christi Patten from Mayo Clinic’s Department of Psychiatry and Psychology in Rochester, Minnesota, USA contributed information for Canada and the USA to the paper titled ‘Smoking in pregnancy among indigenous women in high income countries.’ The paper will be available on line today from Nicotine Tobacco Research.

The researchers want more importance to be placed on supportive programmes for Indigenous pregnant women. They want to see the development and testing of Indigenous-led and culturally-based programmes, such as services that fund Indigenous elders and community health care providers to work with families. Existing stop smoking programmes also needed to improve their delivery to ensure they reach pregnant Indigenous women. 

In reviewing the literature the researchers identified several evidence gaps, which they propose is partly due to the difficulty securing funding for trials that are focused on a relatively small sub-group. The team hopes that working across countries will improve their chances of gaining research funds in future to continue this important line of investigation. Associate Professor Gillian Gould will be visiting Professor Christi Patten at the Mayo Clinic in May 2017 to work on a joint proposal for funding across Indigenous population groups in their respective countries.

About the authors:
Associate Professor Gillian Gould, PhD, MA, MBChB, School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
Gillian focuses on innovative strategies to help Indigenous smokers to quit, including new media and training for health professionals. She is leading a large trial on webinar training about smoking in pregnancy at Aboriginal Community Controlled Health Services.

Associate Professor Marewa Glover, School of Public Health, College of Health, Massey University, Auckland, New Zealand
Marewa has focused her research on smoking reduction for the past 27 years. Her current studies include a trial of a team weight loss competition among the indigenous Māori and Pacific populations in Auckland, a study on parents’ attitudes to childhood obesity and a survey of New Zealand vapers.

Professor Christi Patten, PhD, Mayo Clinic School of Medicine, Rochester, Minnesota, USA 
Dr. Patten’s work focuses on developing novel, theory-based behavioral interventions for tobacco cessation with various populations including Alaska Native pregnant women and children.