title: Knowledge and views about maternal tobacco smoking and barriers for cessation in Aboriginal and Torres Strait Islanders: A systematic review and meta-ethnography.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, Queensland, Australia. gillian.gould1@my.jcu.edu.au
authors.forename: Gillian S
authors.initials: GS
authors.lastname: Gould
authors.forename: Joanne
authors.initials: J
authors.lastname: Munn
authors.forename: Tracey
authors.initials: T
authors.lastname: Watters
authors.forename: Andy
authors.initials: A
authors.lastname: McEwen
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
mesh_terms: D000884:Anthropology, Cultural; D001315:Australia / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006303:Health Services, Indigenous; D006801:Humans; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D012111:Residence Characteristics; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology* / Q000523:psychology; D016540:Smoking Cessation / Q000208:ethnology* / Q000523:psychology; D013315:Stress, Psychological / Q000628:therapy