title: Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review.
abstract: BACKGROUND
  Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies.
  
  
  METHODS
  As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research.
  
  
  RESULTS
  Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches.
  
  
  CONCLUSIONS
  Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted.
  
  
  CONCLUSIONS
  Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Gillian S
authors.initials: GS
authors.lastname: Gould
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
authors.forename: Christi
authors.initials: C
authors.lastname: Patten
authors.affiliation: School of Public Health, College of Health, Massey University, Auckland, New Zealand.
authors.forename: Marewa
authors.initials: M
authors.lastname: Glover
authors.affiliation: Independent Researcher, Manawatu, New Zealand.
authors.forename: Anette
authors.initials: A
authors.lastname: Kira
authors.affiliation: University of Adelaide, Adelaide, South Australia, Australia.|Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia.
authors.forename: Harshani
authors.initials: H
authors.lastname: Jayasinghe
mesh_terms: D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D037001:Directive Counseling; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D007182:Income; D007230:Infant, Low Birth Weight; D009520:New Zealand / Q000453:epidemiology; D011050:Policy Making; D044382:Population Groups / Q000208:ethnology / Q000523:psychology; D011247:Pregnancy; D037841:Pregnant People / Q000208:ethnology / Q000523:psychology; D011295:Prenatal Care / Q000458:organization & administration; D011314:Preventive Health Services / Q000458:organization & administration*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D016540:Smoking Cessation / Q000208:ethnology / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D014481:United States / Q000453:epidemiology