Design and setting: Prospective cohort study embedded within a randomised controlled trial (RCT) performed in the Northern Territory involving participants recruited between 30 June 2006 and 4 May 2010.
Results: There were complete data on women’s smoking status for 121 participants. Among these, the self-reported smoking rate was 45% (95% CI, 36%–55%) during pregnancy, increasing to 63% (95% CI, 54%–71%) at 7 months postpartum. Of the 66 women who were non-smokers at the antenatal visit, 23 (35%; 95% CI, 23%–47%) were smoking by the time their baby reached 7 months of age. Thirty-one per cent (95% CI, 23%–39%) of households included people who smoked inside during the antepartum period, whereas 16% (95% CI, 10%–23%) included people who smoked inside at 7 months postpartum.
Conclusions: While an apparent reduction in indoor exposure to tobacco smoke during the postpartum period is encouraging, this is offset by an increase in the proportion of antenatal non-smokers who subsequently reported smoking after the birth of their child. More health care service delivery and research attention needs to be directed to smoking during pregnancy and to postpartum relapse in this population.
- 1. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health performance framework 2008 report: detailed analyses. Canberra: AIHW, 2009. (AIHW Cat. No. IHW 22.) http://www.aihw.gov.au/publications/index.cfm/title/10664 (accessed Jan 2011).
- 2. Winstanley MH. The health effects of active smoking. In: Scollo MM, Winstanley MH, editors. Tobacco in Australia: facts and issues. 3rd ed. Melbourne: Cancer Council Victoria, 2008.
- 3. The health consequences of smoking: a report of the Surgeon General. Atlanta, Ga: United States Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
- 4. Cook DG, Strachan DP. Health effects of passive smoking 3: parental smoking and prevalence of respiratory symptoms and asthma in school age children. Thorax 1997; 52: 1081-1094.
- 5. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, Ga: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, and Office on Smoking and Health, 2006.
- 6. Alati R, Mamun AA, O’Callaghan M, et al. In utero and postnatal maternal smoking and asthma in adolescence. Epidemiology 2006; 17: 138-144.
- 7. Peat JK, Toelle BG, Marks GB, Mellis CM. Continuing the debate about measuring asthma in population studies. Thorax 2001; 56: 406-411.
- 8. Lumley J, Chamberlain C, Dowswell T, et al. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2009; (3): CD001055.
- 9. McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18: 156-170.
- 10. Fang WL, Goldstein AO, Butzen AY, et al. Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies. J Am Board Fam Pract 2004; 17: 264-275.
- 11. Mullen PD. How can more smoking suspension during pregnancy become lifelong abstinence? Lessons learned about predictors, interventions, and gaps in our accumulated knowledge. Nicotine Tob Res 2004; 6 Suppl 2: S217-S238.
- 12. Anderka M, Romitti PA, Sun LX, et al. Patterns of tobacco exposure before and during pregnancy. Acta Obstet Gynecol Scand 2010; 89: 505-514.
- 13. Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res 2004; 6 Suppl 2: S125-S140.
- 14. Mohsin M, Bauman AE. Socio-demographic factors associated with smoking and smoking cessation among 426 344 pregnant women in New South Wales, Australia. BMC Public Health 2005; 5: 138.
- 15. Wood L, France K, Hunt K, et al. Indigenous women and smoking during pregnancy; knowledge, cultural contexts and barriers to cessation. Soc Sci Med 2008; 66: 2378-2389.
- 16. Heath D, Panaretto K, Manessis V, et al. Factors to consider in smoking interventions for Indigenous women. Aust J Prim Health 2006; 12: 131-135.
- 17. Passey M, Gale J, Holt B, et al. Stop smoking in its tracks: understanding smoking by rural Aboriginal women. Rural health: the place to be. 10th National Rural Health Conference; 2009 May 17-20; Cairns, Australia. http://10thnrhc.ruralhealth.org.au/papers/docs/Passey_Megan_D9.pdf (accessed Jan 2011).
- 18. van der Sterren A; Goreen Narrkwarren Ngrn-toura – Healthy Family Air (Reducing Smoking amongst Pregnant Aboriginal Women in Victoria: An Holistic Approach) Project Team. Goreen Narrkwarren Ngrn-toura – healthy family air: a literature review to inform the VACCHO Smoking amongst Pregnant Aboriginal Women Research Project. Melbourne: Victorian Aboriginal Community Controlled Health Organisation, 2010. http://www.vaccho.org.au/rw_documents/Healthy%20Family%20 Air%20Review-FINAL%20WEB-2.pdf (accessed Jan 2011).
- 19. Dunbar M, Moberley S, Nelson S, et al. Clear not simple: an approach to community consultation for a maternal pneumococcal vaccine trial among Indigenous women in the Northern Territory of Australia. Vaccine 2007; 25: 2385-2388.
- 20. Australian Bureau of Statistics. Births, Australia, 2009. Canberra: ABS, 2010. (ABS Cat. No. 3301.0.) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3301.02009?OpenDocument (accessed Jan 2011).
- 21. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Social Survey 2008. Canberra: ABS, 2009. (ABS Cat. No. 4714.0.) http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbytitle/ABB28B9B3A 7D6E4ACA25765E0021ADAE?OpenDocument (accessed Jan 2011).
- 22. Zhang X, Johnstone K. Northern Territory midwives' collection: mothers and babies 2005. Darwin: Northern Territory Government Department of Health and Families, 2009.
- 23. Panaretto KS, Mitchell MR, Anderson L, et al. Tobacco use and measuring nicotine dependence among urban Indigenous pregnant women. Med J Aust 2009; 191: 554-557. <MJA full text>
- 24. Gilligan C, Sanson-Fisher R, Eades S, D’Este C. Antenatal smoking in vulnerable population groups: an area of need. J Obstet Gynaecol 2007; 27: 664-671.
- 25. Gilligan C, Sanson-Fisher R, Eades S, et al. Assessing the accuracy of self-reported smoking status and impact of passive smoke exposure among pregnant Aboriginal and Torres Strait Islander women using cotinine biochemical validation. Drug Alcohol Rev 2010; 29: 35-40.
- 26. Gilligan C, Sanson-Fisher RW, D’Este C, et al. Knowledge and attitudes regarding smoking during pregnancy among Aboriginal and Torres Strait Islander women. Med J Aust 2009; 190: 557-561. <MJA full text>
- 27. Hajek P, Stead LF, West R, et al. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev 2009; (1): CD003999.
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