title: "Nobody smokes in the house if there's a new baby in it": Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia.
abstract: BACKGROUND
  Smoking prevalence in Aboriginal and Torres Strait Islander pregnant women is quadruple that of non-Indigenous counterparts, impacting on the health of babies and children.
  
  
  OBJECTIVE
  To explore attitudes and experiences related to prenatal tobacco smoking by Aboriginal women and household smoking, and to provide recommendations for culturally appropriate interventions.
  
  
  METHODS
  We conducted five focus groups with clients and family members of a regional NSW Aboriginal maternity service (n=18). Committees, including Aboriginal representatives, oversaw the study. We analysed transcripts with the constant comparative method and developed key categories.
  
  
  RESULTS
  Categories included: social and family influences, knowing and experiencing the health effects of smoking, responses to health messages, cravings and stress, giving up and cutting down, managing smoke-free homes and cars, and community recommendations. Smoking in pregnancy and passive smoking were acknowledged as harmful for babies and children. Anti-tobacco messages and cessation advice appeared more salient when concordant with women's lived experience. Reduced cigarette consumption was reported in pregnancy. Despite smoking in the home, families were engaged in the management of environmental tobacco smoke to reduce harm to babies and children. Abstinence was difficult to initiate or maintain with the widespread use of tobacco in the social and family realm.
  
  
  CONCLUSIONS
  Anti-tobacco messages and interventions should relate to Aboriginal women's experiences, improve understanding of the quitting process, support efficacy, and capitalise on the positive changes occurring in smoke-free home management. Focus group participants recommended individual, group and family approaches, and access to cessation services and nicotine replacement therapy for Aboriginal pregnant women who smoke.
authors.affiliation: School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, PO Box 6811, Cairns, Queensland 4870, Australia; Southern Cross University, Hogbin Drive, Coffs Harbour, NSW 2450, Australia; North Coast Medicare Local, 92 Harbour Drive, Coffs Harbour, NSW 2450, Australia. Electronic address: 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: Sandra
authors.initials: S
authors.lastname: Avuri
authors.forename: Susan
authors.initials: S
authors.lastname: Hoff
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cadet-James
authors.forename: Andy
authors.initials: A
authors.lastname: McEwen
authors.forename: Alan R
authors.initials: AR
authors.lastname: Clough
mesh_terms: D000293:Adolescent; D000328:Adult; D003469:Culture; D005191:Family Characteristics; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011247:Pregnancy; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology* / Q000523:psychology; D016540:Smoking Cessation / Q000208:ethnology* / Q000379:methods / Q000523:psychology; D012944:Social Support; D055815:Young Adult; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Maternal smoking; Nicotine replacement therapy; Oceania Ancestry Group; Passive smoking; Smoking cessation