Smoking During Pregnancy In Indigenous Community: Effects And Barriers To Cessation

Prevalence of Smoking during Pregnancy in the Indigenous Community

Discuss about the Factors that Impede or Facilitate Smoking Cessation in Pregnant Women in the Indigenous Community of Australia.

World Health Organization (WHO), has termed tobacco use to be a global epidemic as it has a high prevalence and has continued to be used worldwide. Smoking is of particular concern among the indigenous community although all that is known, is known through reports obtained from Australia, New Zealand, Canada and United Kingdom. It has been noted that in these countries the indigenous people smoking rate is twice or higher than the general community. According to the Substance Abuse and Mental Health Services Administration, (2012) sixteen percent (16%) of pregnant women have a smoking habit.

In Australia the smoking rates are very low, although the Aboriginal people are likely to smoke three to more times than the non-Aboriginal community. In pregnancy this gets worse as 48% of Aboriginal women smoke as compared to the 13% of the non-Aboriginals. Among the adolescent population the Aboriginals are likely to smoke three to four times more than the non-Aboriginals.

Smoking during the pregnancy phase raises an alarm as not only does it affect the general health of the pregnant woman, it has adverse effects on the outcomes of the pregnancy, the fetus health, child’s health to adulthood years (Oken et al., 2008; Syme et al., 2010; Power et al., 2010). The fatal consequences include; placental abruption, placental Previa, premature delivery, low birth weight during pregnancy and cleft plate and cleft lip and lung function impairment at birth.  In addition to this, the behavioral disorders during childhood and the genital abnormalities have been traced back to smoking during pregnancy (obesity and overweight, attention deficit hyperactivity, risks of metabolic disorders and cardiovascular illness.

In addition to these, it has effects on DNA methylation (DNAm) modulation. DNAm has a major function in regulation of the gene expression and the genomic architecture (Tsukahra et al. 2009; Levin and Moran 2011). Cigarettes smoke has been found to be having carcinogens, carbon monoxide, and nicotine in large quantities which modifies the DNAm altering cell division and differentiation Di et al., 2012). These chemicals are easily passed to the unborn child via the placenta (Joubert et al., 2012). It has also been found out that DNAm persists even after birth causing genetic abnormalities.

Lastly, women who smoke during pregnancy continues with this habit during the postpartum period. This exposes the newborn to nicotine during breastfeeding. Breast milk is the one nutrition for newborn although these women who smoke tend to stop breastfeeding earlier than the non-smoking mothers. This denies these children the nutritional value of the breast milk. For the few who still breastfeed and smoke, they expose the newborns to the effects of secondhand smoking.

Adverse Effects of Smoking during Pregnancy

‘The factors that impede or facilitate Smoking cessation in Pregnant women in the Indigenous Community of Australia (Tasmania).’

Smoking is of particular concern among the indigenous community although all that is known, is known through reports obtained from Australia, New Zealand, Canada and United Kingdom. It has been noted that in these countries the indigenous people smoking rate is twice or higher than the general community. According to the Substance Abuse and Mental Health Services Administration, (2012) sixteen percent of pregnant women have a smoking habit. Smoking during the pregnancy phase raises an alarm as not only does it affect the general health of the pregnant woman, it has adverse effects on the outcomes of the pregnancy, the fetus health, child’s health to adulthood years (Oken et al., 2008; Syme et al., 2010; Power et al., 2010). The fatal consequences include; placental abruption, placental Previa, premature delivery, low birth weight during pregnancy and cleft plate and cleft lip and lung function impairment at birth.  In addition to this, the behavioral disorders during childhood and the genital abnormalities have been traced back to smoking during pregnancy.

Research Methodology.

Methods: A systematic review on published academic sources using standardized keywords (pregnancy smoking, effects of smoking, complications in pregnancy) on the following databases; Medline, Cochrane library, Clinical government trials, CINAHL, and the Web of Science) to find out the effects of smoking during pregnancy in the indigenous community. The Critical Appraisal Checklist for Qualitative Research (CASP) was used so as to analyze the data obtained and determine its validity and reliability to the research question. Are the research questions answered by the sources obtained? Themes were developed at the analysis stage. These themes led to development of recommendation which are based on PARiHS framework.

Study variables

The validity, reliability and the eligibility of the literature sources was tested using a systematic approach so as to determine those that best answered the research question. PICO was formulated so as to make this possible.

Population	Females at childbearing age (Indigenous community).
Intervention	Increase the cessation rates of pregnancy smoking among the indigenous community.
Counter Intervention	Socio-economic status, level of knowledge, ethnicity(indigenous community), culture
Outcome	Have a community with reduced pregnancy smoking.

Table 1: PICO.

These table provided the keywords that were used in the specified databases. The sources obtained were sufficient to conduct the study.

Sampling (The study population)

Selecting the Literature and Exclusion/Inclusion Criteria

Inclusion criteria	Exclusion criteria
Women	Men
Women of childbearing age.	Women who are below or above childbearing age.
Indigenous community.	Non-smoking women.
Pregnant women who smoking	Articles older than seven years.
The effects of pregnancy smoking.
Literate and illiterate
Low, medium and high income earners.
Worldwide research
All published materials that are relevant
Articles that are five to seven years old.

Table 2: Inclusion and exclusion criteria.

For an in-depth research and the understanding of the research question, its effectiveness to the addressed interventions, six sources were chosen so as to be used as randomized control trials. They were chosen using the traditional hierarchy of evidence (Greenhalgh, 1997: Guyatt, et al., 1995).

Modulation of DNA Methylation

Outcome Consideration for Inclusion

No	Consideration
1	Effects of smoking during pregnancy.
2	Effects of smoking during pregnancy in the indigenous community.
3	Factors influencing Smoking among the indigenous community especially pregnant women.
4	Benefits of smoking cessation during pregnancy.

Table 3

Considering that this study is a systematic review of previous researchers done with the theme of smoking cessation among the Aboriginals, this makes the data secondary and prone to errors and biasness. 

Ethical considerations.

This is a systematic review of peer reviewed literature, therefore there is no contact with people, the only ethical consideration is by ensuring that the articles used were obtained using the right channels.

Factors that impede smoking cessation among the Aboriginals:

The Aboriginal’s high rates of smoking among women has been linked to the systematic history of being marginalized (Greaves et al., 2013). The high difference between the Aboriginals rate of smoking and the non-Aboriginals has been associated with their low socio-economic status. The low socio-economic status is associated with the initiation of the smoking habit. The low socio-economic status is associated with illiteracy, poor child health care and lack of transport cost. These factors affect their accessibility to the cessation interventions (Brussoni, Olsen, & Joshi, 2012).

It is very important to formulate and implement culturally appropriate smoking models as the ones that ignores the cultural impact and the social context during pregnancy among the Aboriginals were doomed ineffective (Varcoe et al., 2010). In the Aboriginals community there are different viewpoints on what health and illnesses constitutes (Loppie Reading & Wien, 2009; Kendall, 2009) and tobacco holds a lot of value in their native culture as it has greatly been used in ceremonies and prayers in the Aboriginal community.

Tobacco dependency has been found to be the major cause of relapses and difficulties to quit smoking among the pregnant Aboriginal women (Bertollini, Ribeiro, Mauer-Stender, & Galea, 2016).

There are high rates of mental health disorders, stress and trauma among pregnant Aboriginal women and their families. This has been associated with their high rates of smoking. The stress is highly contributed by lack of family support during pregnancy, social stresses for example financial problems and the relationship problems. Most of them uses smoking as a coping mechanism (Campbell, 2010).

A high percent of the Aboriginal community smokes, this makes it hard for the pregnant woman to quit smoking. In addition to this, they lack social support while quitting. They lack mentors/advisors to walk with them as they quit smoking during pregnancy. This decreases the cessation rates of pregnancy smoking (Small, Porr, Swab, & Murray, 2018).

Smoking cessations strategies that are women centered.

Barriers to Smoking Cessation among the Indigenous Community

It has been found out that when the cessation methods are women centered they have been effective. These strategies focus on the holistic, comprehensive, health of the woman and the factors that are attributed to the smoking. Not only is the woman taught on the importance of cessation of smoking to the baby but also to their health (Wyndow, Walker, & Reibel, 2018).

Conclusion

In summary, the factors that impede smoking cessation of the pregnant indigenous women are; low socio-economic status, lack of culturally appropriate cessation models, dependency to tobacco use, stress and lack of social support. Secondly, the factors that facilitates smoking cessation is having a women centered cessation models. To increase cessation rates the factors impeding should be dealt with.

References

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