School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
Hunter Medical Research Institute, Level 4-West, 1/1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
Nicotine Tob Res. 2021 May 24;23(6):888-899. doi: 10.1093/ntr/ntab003.
With a high prevalence of smoking during pregnancy and limited Indigenous-specific evidence for treatment, we used socioecological mapping to identify multilevel barriers and enablers to smoking cessation related to Indigenous Australian pregnant and postpartum women.
Nine electronic databases were searched. Original studies except interventions and trials, published in English, up to February 29, 2020 were included. Studies were appraised using the QualSyst tool. Evidence was narratively synthesized. The review protocol was registered with PROSPERO (CRD42019135543).
A total of 15 studies (10 quantitative, 5 qualitative) were included, covering 1306 women, 3 partners/family members, 234 health professionals (HP), and 2755 patient records. Complex and overlapping barriers were identified at individual, family, community, societal, and system levels. Socioeconomic disadvantages, inequality, and pervasive racism as legacies of colonization, combined with personal, family, and community circumstances intensified individual experiences of stress, which may be heightened during pregnancy. Inadequate smoking cessation care (SCC), inconsistent antitobacco messages, and ineffectual HP interventions underscore a need for service enhancement and further evidence to develop culturally relevant messages. High motivation of pregnant women to quit, resilience, and supports available in the family and community are strengths that warrant attention in future interventions.
SCC without ameliorating the social disadvantages and the disparities in health determinants between Indigenous and non-Indigenous Australian women may limit the effectiveness of SCC. A comprehensive approach is required that includes policy changes for addressing external stressors the women experience, engagement of family and community, and better training of HP and provision of free pharmacotherapy.
To systematically address barriers to smoking cessation at multiple levels, initiatives to ameliorate social disadvantages and discrepancies in social determinants of health between Indigenous and non-Indigenous Australians are required to be taken in tandem with SCC. Initiatives may include making relevant policy changes and allocating more resources for education, employment, housing, and community development. Enhancement of knowledge, skills, and confidence of HP regarding the provision of high-quality SCC for Indigenous women and their families is warranted. Future interventions may build on high motivation, resilience, and strengths of individual women, and incorporate support strategies engaging family and community.
由于怀孕期间吸烟的高发率和针对土著人群的治疗方法有限，我们使用社会生态学绘图来确定与澳大利亚土著孕妇和产后妇女戒烟相关的多层次障碍和促进因素。
我们搜索了九个电子数据库。纳入了除干预措施和试验以外的、发表在英语期刊上的原始研究，时间截至 2020 年 2 月 29 日。使用 QualSyst 工具对研究进行评估。对证据进行了叙述性综合。该综述方案已在 PROSPERO（CRD42019135543）上注册。
共纳入 15 项研究（10 项定量研究，5 项定性研究），共纳入 1306 名女性、3 名伴侣/家庭成员、234 名卫生保健专业人员（HP）和 2755 份患者记录。在个人、家庭、社区、社会和系统层面都发现了复杂且相互重叠的障碍。社会经济劣势、不平等和殖民化遗留下来的普遍种族主义，加上个人、家庭和社区的情况，加剧了个人的压力体验，而在怀孕期间这种压力体验可能会加剧。戒烟护理（SCC）不足、反烟草信息不一致以及 HP 干预措施无效，这突出表明需要加强服务并进一步提供证据来制定与文化相关的信息。孕妇强烈的戒烟动机、韧性以及家庭和社区中提供的支持是未来干预措施中值得关注的优势。
如果不改善土著澳大利亚女性和非土著澳大利亚女性之间的社会劣势和健康决定因素方面的差异，SCC 可能会限制其效果。需要采取综合方法，包括解决女性所经历的外部压力源的政策变革、家庭和社区的参与以及更好地培训卫生保健专业人员并提供免费的药物治疗。
为了系统地解决多层次的戒烟障碍，需要采取措施改善土著澳大利亚人和非土著澳大利亚人之间的社会劣势和健康决定因素方面的差异，同时还要进行 SCC。这些措施可能包括进行相关政策变革并为教育、就业、住房和社区发展分配更多资源。需要增强卫生保健专业人员在为土著妇女及其家庭提供高质量 SCC 方面的知识、技能和信心。未来的干预措施可以建立在个人女性的高动机、韧性和优势的基础上，并纳入家庭和社区参与的支持策略。
