title: Factors associated with antenatal smoking among Aboriginal and Torres Strait Islander women in two jurisdictions.
abstract: OBJECTIVE
  Smoking rates are three times as high for pregnant Indigenous women relative to non-Indigenous women, in Australia. This paper describes Indigenous women's self-reported antenatal smoking behaviour and compares knowledge and attitudes of those who: (i) smoke and don't smoke during pregnancy; and (ii) quit or continued to smoke since the beginning of pregnancy.
  
  
  METHODS
  Cross-sectional surveys with 264 pregnant Indigenous women in two states collected data on smoking status, antenatal changes, risk knowledge, attitudes to smoking and sociodemographic characteristics. Multivariable logistic regression analyses assessed associations between knowledge and attitude variables and smoking status and antenatal changes in smoking status.
  
  
  RESULTS
  Forty-six per cent of the women (n = 121) reported currently smoking. The majority (68%) who smoked at the beginning of pregnancy reported quitting (21%) or reducing (47%). Relative to smokers, non-smokers had more schooling (P = 0.002), more post-secondary education (P = 0.023), lower parity (P = 0.003), better understanding of smoking-related risks (miscarriage P = 0.01; low birth weight P = 0.003; infant illness P < 0.001; childhood behavioural problems P = 0.007), and less frequently expressed attitudes indicating that quitting was very difficult given other problems they faced. Similar patterns were found for women who quit during pregnancy compared to those who continued smoking.
  
  
  CONCLUSIONS
  Increasing awareness of antenatal smoking risks and the benefits of quitting may motivate women to attempt to quit. However, knowledge alone is unlikely to be sufficient considering the life circumstances of many Indigenous women. Addressing the social environment and daily stressors, particularly those exacerbated by pregnancy, may be critical to supporting quit attempts.
authors.affiliation: University Centre for Rural Health-North Coast, School of Public Health, University of Sydney, Lismore, Australia. megan.passey@ucrh.edu.au
authors.forename: Megan E
authors.initials: ME
authors.lastname: Passey
authors.forename: Catherine A
authors.initials: CA
authors.lastname: D'Este
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Stirling
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sanson-Fisher
mesh_terms: D000328:Adult; D001315:Australia; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D009042:Motivation; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control*; D012306:Risk; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D016540:Smoking Cessation / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D012931:Social Environment; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples