Chronological narratives of smoking and being smoke-free in pregnancy by Aboriginal Australian women in New South Wales: a qualitative study

Introduction: Smoking prevalence is four times higher in pregnant Indigenous Australian women than non-Indigenous counterparts (47%versus 13%). The study aimed to provide an opportunity for Aboriginal women to tell their own story about smoking and quitting, and their trajectory of smoking once becoming pregnant. Methods: Aboriginal women (N=20) who experienced smoking or quitting in pregnancy were interviewed by a female Aboriginal researcher using Aboriginal traditions of storytelling. Audio transcripts were analyzed using NVivo, with inductive methods. Researchers (GG–non-Aboriginal; MB–Aboriginal) agreed on a coding structure. The voices of the women participants were privileged in the thematic analysis, in discussion with a senior Aboriginal academic (YC) and an Aboriginal obstetrician (MC).Results: The journey from initiation to becoming a regular smoker, then pregnant, was described. Narrative themes were situated in the contexts of participants’ lives, including their Aboriginal community connections and origins. Narratives included key characters, such as mother, father, partners and friends, health professionals, environments and events impacting on smoking and quitting, start stories (experimenting to becoming a regular smoker), stop stories (cutting down and quitting) and turning points – new responsibilities on becoming pregnant. Women spoke of their lack of follow-up from health professionals, and how they could be better supported to quit: Elders were important as role models. Conclusions: Women’s narratives of smoking and quitting provided insight to strengthen the opportunities for behavior change. The findings will help us engage with Aboriginal pregnant women, support them with culturally competent smoking cessation care, and develop new approaches.