24–26 Literature reviews highlighted research gaps and opportunities in smoking in pregnancy among women in low- and middle-income countries. 20–23 Other research has assessed knowledge and attitudes to smoking among pregnant Indigenous women. A systematic review by Washio and Cassey 18 identified only one study 19 and we have identified four more. ![]() 14–16ĭespite the identified need for research on strategies for decreasing smoking while pregnant among Indigenous women, 17 very few interventional studies have focused on this population. 15 These potential adverse health outcomes are especially relevant for populations with disproportionately high prevalence of tobacco use, including Indigenous peoples. Thus, a vicious cycle is established, with intergenerational impacts from tobacco smoking. 9–13 Through prenatal exposure, children born to mothers who smoke are more likely to become smokers themselves 14 and sustain chronic detriments, for example, increased asthma risks. 2, 3, 5–8 Similarly, a number of studies report adverse health risks of prenatal smokeless tobacco (ST) use including increased risk for preterm birth, stillbirth, and low birth weight. 2–7 Babies and children exposed to the toxic effects of environmental and inter-uterine metabolites from tobacco smoke can experience prenatal and birthing risks, low birth weight, and ongoing developmental problems. 3, 4 The adverse effects of cigarette smoking during pregnancy and after delivery on maternal, fetal, and infant health is well-documented. Tobacco smoking is one of the most significant reversible risk factors for the health of Indigenous pregnant women and their babies. 1, 2 This disadvantaged context negatively impacts tobacco use and the ability to quit smoking among women. 1, 2 While the contexts for Indigenous women vary across these countries, colonization has resulted in inequitable access to education and health care disproportionate exposure to environmental risks to health discrimination in the workplace disproportionately higher unemployment, along with over-representation among lower socioeconomic levels of society, being more likely to live in deprived areas, and higher incarceration rates. The Indigenous women of these countries are disadvantaged in multiple ways, which has a historical basis in that they were colonized by Western nation-states. This article focuses on Indigenous women from four high-income countries: the United States (USA), Canada, Australia, and New Zealand (NZ). There are over 300 Indigenous peoples in the world. Smoking prevalence is often higher among pregnant women in disadvantaged circumstances, 1, 2 for example, among Indigenous women. ![]() 1, 2 Globally tobacco smoking has complex links with the social determinants of health and thus has a high impact on populations suffering from health disparities. Tobacco smoking is a marker of and a pervasive cause of social and economic disadvantage.
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