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Addressing Smoking Cessation Among Pregnant Aboriginal Women: Challenges and Gaps in Knowledge

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Addressing Smoking Cessation Among Pregnant Aboriginal Women: Challenges and Gaps in Knowledge ADDRESSING SMOKING CESSATION AMONG PREGNANT ABORIGINAL WOMEN: CHALLENGES AND GAPS IN KNOWLEDGE by Emily Campbell Bachelor of Science, University of Victoria, 2005 PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH In the Faculty of Health Sciences © Emily Campbell 2010 SIMON FRASER UNIVERSITY Fall 2010 All rights reserved. However, in accordance with the Copyright Act of Canada, this work may be reproduced, without authorization, under the conditions for Fair Dealing. Therefore, limited reproduction of this work for the purposes of private study, research, criticism, review and news reporting is likely to be in accordance with the law, particularly if cited appropriately. APPROVAL Name: Emily Campbell Degree: Master of Public Health Title of Thesis: Addressing Smoking Cessation among Pregnant Aboriginal Women: Challenges and Gaps in Knowledge Examining Committee: Chair: Dr. Kitty Corbett Professor, Faculty of Health Sciences ______________________________________ Dr. Stephen Corber Senior Supervisor Associate Professor Faculty of Health Sciences ______________________________________ Lucy Barney Supervisor Provincial Leader, Aboriginal Health, Perinatal Services BC, Provincial Health Services Authority ______________________________________ Dr. John O’Neil External Examiner Professor, Dean Faculty of Health Sciences Date Defended/Approved: December 21, 2010 ii Declaration of Partial Copyright Licence The author, whose copyright is declared on the title page of this work, has granted to Simon Fraser University the right to lend this thesis, project or extended essay to users of the Simon Fraser University Library, and to make partial or single copies only for such users or in response to a request from the library of any other university, or other educational institution, on its own behalf or for one of its users. The author has further granted permission to Simon Fraser University to keep or make a digital copy for use in its circulating collection (currently available to the public at the “Institutional Repository” link of the SFU Library website <www.lib.sfu.ca> at: <http://ir.lib.sfu.ca/handle/1892/112>) and, without changing the content, to translate the thesis/project or extended essays, if technically possible, to any medium or format for the purpose of preservation of the digital work. The author has further agreed that permission for multiple copying of this work for scholarly purposes may be granted by either the author or the Dean of Graduate Studies. It is understood that copying or publication of this work for financial gain shall not be allowed without the author’s written permission. Permission for public performance, or limited permission for private scholarly use, of any multimedia materials forming part of this work, may have been granted by the author. This information may be found on the separately catalogued multimedia material and in the signed Partial Copyright Licence. While licensing SFU to permit the above uses, the author retains copyright in the thesis, project or extended essays, including the right to change the work for subsequent purposes, including editing and publishing the work in whole or in part, and licensing other parties, as the author may desire. The original Partial Copyright Licence attesting to these terms, and signed by this author, may be found in the original bound copy of this work, retained in the Simon Fraser University Archive. Simon Fraser University Library Burnaby, BC, Canada Last revision: Spring 09 ABSTRACT The high prevalence of smoking among pregnant Aboriginal women – including First Nations, Inuit and Métis women - has been identified as a public health concern in Canada. There is a paucity of research exploring socio-cultural influences on maternal smoking cessation and culturally appropriate interventions for Aboriginal women. Aboriginal people embrace a holistic view that reflects the interrelatedness of the physical, spiritual, emotional and mental dimensions of health. These must be acknowledged when addressing smoking cessation. In order to address the high prevalence of Aboriginal women who smoke during pregnancy there is a need for a better understanding of women’s experiences of smoking during pregnancy and their own knowledge, beliefs and personal barriers with regard to quitting smoking. The purpose of this paper is to identify the challenges and knowledge gaps in addressing Aboriginal maternal smoking cessation, in addition to proposing specific culturally appropriate recommendations for future research. Keywords: Aboriginal health, pregnant women, smoking cessation. iii DEDICATION To Adam, For putting up with my never-ending procrastination and always reminding me what I can do, even when I think I can’t… Love, Emily iv ACKNOWLEDGEMENTS My capstone journey would not have been possible without the help and support of many people along the way. Special thanks to my senior supervisor Dr. Steve Corber for his continual support and guidance not only through this capstone project but through the entire MPH program. I admire the way he disregards my compliments about his dedication and excellence as a professor, and his regular response that “I am just doing my job”. Despite what he says, he has always gone ‘above and beyond’ what could be expected and I honestly do not think I would have made it through without him. I am very grateful to Lucy Barney for her willingness to accept the challenge of being my supervisor. Her insights and contributions have been invaluable, stretching my knowledge and motivating me to continue with this learning process. Thank you to Dr. John O’Neil for taking the time to participate as my external examiner and for providing such constructive feedback and valuable insight. I would also to thank Dr. Kitty Corbett for chairing my defense and for providing a keen interest in my project. Finally, I would like to acknowledge Dr. Charmaine Enns and Darlene Martin for their ever inspiring dedication to improving Aboriginal health; I am so very grateful to have had the opportunity to be mentored by them both. v TABLE OF CONTENTS Approval .......................................................................................................................... ii Abstract .......................................................................................................................... iii Dedication....................................................................................................................... iv Acknowledgements ........................................................................................................ v Table of Contents........................................................................................................... vi 1: Background................................................................................................................. 1 2: Introduction................................................................................................................. 8 3: Rationale.................................................................................................................... 10 4: Methods..................................................................................................................... 11 5: Results....................................................................................................................... 14 5.1 Challenges for Aboriginal Women to Quit Smoking ............................................... 14 5.1.1 Socio Economic Status.................................................................................... 15 5.1.2 Lack of Culturally Appropriate Smoking Cessation Models ............................. 16 5.1.3 Relative Importance of Smoking Cessation ..................................................... 19 5.1.4 The Social Phenomenon of Smoking............................................................... 20 5.2 Gaps in Knowledge and Practice ........................................................................... 21 5.2.1 Lack of Culturally Appropriate Research in Aboriginal Maternal Smoking ...... 23 5.2.2 Lack of Evaluated Cessation Programs for Aboriginal Women ....................... 27 5.3 Maternal Smoking Cessation Models..................................................................... 29 6: Discussion................................................................................................................. 35 6.1 Recommendations ................................................................................................. 35 6.1.1 Addressing the Gaps in Knowledge................................................................. 35 6.1.2 Addressing the Challenges of Smoking Cessation .......................................... 39 7: Conclusion ................................................................................................................ 44 8: Critical Reflection ..................................................................................................... 46 Reference List ............................................................................................................... 48 Appendices.................................................................................................................... 56 Appendix 1: Canadian Research on Aboriginal Maternal Smoking ................................ 57 Appendix 2: Canadian Smoking Cessation Resources for Pregnant Aboriginal Women63 Appendix 3: Canadian Smoking Cessation
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