School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, Queensland, Australia.
Nicotine Tob Res. 2013 May;15(5):863-74. doi: 10.1093/ntr/nts211. Epub 2012 Oct 4.
Maternal smoking rates in Australian Aboriginal women are triple that of the general population, with little evidence for successful interventions. We reviewed the literature to understand smoking and cessation in Aboriginal and Torres Strait Islander women and provide recommendations for targeted interventions.
Six databases were searched using terms related to smoking, pregnancy, and Aboriginal Australians. Two reviewers independently assessed papers for inclusion and quality. Meta-ethnography synthesized first- and second-order constructs from included studies and constructed a line of argument.
Seven relevant studies were analyzed. The synthesis illustrates 11 third-order constructs operating on the levels of self, family, and social networks, the wider Aboriginal community, and broader external influences. Highlighted are social norms and stressors within the Aboriginal community perpetuating tobacco use; insufficient knowledge of smoking harms; inadequate saliency of antismoking messages; and lack of awareness and use of pharmacotherapy. Indigenous Health Workers have a challenging role, not yet fulfilling its potential. Pregnancy is an opportunity to encourage positive change where a sense of a "protector role" is expressed.
This review gives strength to evidence from individual studies across diverse Indigenous cultures. Pregnant Aboriginal and Torres Strait Islander smokers require comprehensive approaches, which consider the environmental context, increase knowledge of smoking harms and cessation methods, and provide culturally targeted support. Long term, broad strategies should de-normalize smoking in Aboriginal and Torres Strait Islander communities. Further research needs to examine causes of resistance to antitobacco messages, clarify contributing roles of stress and depression, and attitudes to pharmacotherapy.
澳大利亚原住民女性的吸烟率是总人口的三倍，而成功的干预措施却很少。我们回顾了文献，以了解原住民和托雷斯海峡岛民女性的吸烟和戒烟情况，并为有针对性的干预措施提供建议。
使用与吸烟、怀孕和澳大利亚原住民相关的术语，在六个数据库中进行了搜索。两名评审员独立评估论文是否符合纳入标准和质量标准。元民族志综合了纳入研究的第一级和第二级结构，并构建了一个论证。
分析了七项相关研究。综合分析说明了在自我、家庭和社交网络、更广泛的原住民社区以及更广泛的外部影响等层面上运作的 11 个第三级结构。突出的是在原住民社区中持续存在的社会规范和压力源，这些压力源促使人们使用烟草；对吸烟危害的认识不足；反吸烟信息的重要性不足；以及对药物治疗的认识和使用不足。原住民卫生工作者的角色具有挑战性，但尚未发挥其潜力。怀孕是一个鼓励积极改变的机会，在这个机会中表达了一种“保护者角色”的意识。
这篇综述增强了来自不同原住民文化的个体研究的证据。需要对怀孕的原住民和托雷斯海峡岛民吸烟者采取全面的方法，这些方法需要考虑环境背景，增加对吸烟危害和戒烟方法的了解，并提供有针对性的文化支持。从长远来看，应采取广泛的策略，使吸烟在原住民和托雷斯海峡岛民社区中不再正常化。需要进一步研究以研究抵制反烟草信息的原因，阐明压力和抑郁的作用，以及对药物治疗的态度。
