Skip to main content
SpringerLink
Log in

Exercise to Support Indigenous Pregnant Women to Stop Smoking: Acceptability to Māori

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives Smoking during pregnancy is harmful for the woman and the unborn child, and the harms raise risks for the child going forward. Indigenous women often have higher rates of smoking prevalence than non-indigenous. Exercise has been proposed as a strategy to help pregnant smokers to quit. Māori (New Zealand Indigenous) women have high rates of physical activity suggesting that an exercise programme to aid quitting could be an attractive initiative. This study explored attitudes towards an exercise programme to aid smoking cessation for Māori pregnant women. Methods Focus groups with Māori pregnant women, and key stakeholder interviews were conducted. Results Overall, participants were supportive of the idea of a physical activity programme for pregnant Māori smokers to aid smoking cessation. The principal, over-arching finding, consistent across all participants, was the critical need for a Kaupapa Māori approach (designed and run by Māori, for Māori people) for successful programme delivery, whereby Māori cultural values are respected and infused throughout all aspects of the programme. A number of practical and environmental barriers to attendance were raised including: cost, the timing of the programme, accessibility, transport, and childcare considerations. Conclusions A feasibility study is needed to design an intervention following the suggestions presented in this paper with effort given to minimising the negative impact of barriers to attendance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Ananth, C. V., Smulian, J. C., Demissie, K., Vintzileos, A. M., & Knuppel, R. A. (2001). Placental abruption among singleton and twin births in the United States: Risk factor profiles. American Journal of Epidemiology, 153, 771–778.

    Article  CAS  PubMed  Google Scholar 

  • Ayer, J. G., Belousova, E., Harmer, J. A., David, C., Marks, G. B., & Celermajer, D. S. (2011). Maternal cigarette smoking is associated with reduced high-density lipoprotein cholesterol in healthy 8-year-old children. European Heart Journal, 32(19), 2446–2453. doi:10.1093/eurheartj/ehr174.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Batstra, L., Hadders-Algra, M., & Neeleman, J. (2003). Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: Prospective evidence from a Dutch birth cohort. Early Human Development, 75(1–2), 21–33.

    Article  CAS  PubMed  Google Scholar 

  • Bernard, H. (2000). Social research methods. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Buchan, P. C. (1983). Cigarette smoking in pregnancy and fetal hyperviscosity. BMJ (Clinical Research ed.), 286(6374), 1315.

    Article  CAS  Google Scholar 

  • Buka, S. L., Shenassa, E. D., & Niaura, R. (2003). Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: A 30-year prospective study. American Journal of Psychiatry, 160, 1978–1984.

    Article  PubMed  Google Scholar 

  • Castles, A., Adams, E. K., Melvin, C. L., Kelsch, C., & Boulton, M. L. (1999). Effects of smoking during pregnancy. Five meta-analyses. American Journal of Preventive Medicine, 16, 208–215.

    Article  CAS  PubMed  Google Scholar 

  • Chamberlain, C., O’Mara-Eves, A., Oliver, S., Caird, J. R., Perlen, S. M., Eades, S. J., & Thomas, J. (2013). Psychosocial interventions for supporting women to stop smokers in pregnancy. Cochrane Database of Systematic Reviews (Online), 10, CD001055.

    Google Scholar 

  • Charlton, A. (1996). Children and smoking: The family circle. British Medical Bulletin, 52, 90–107.

    Article  CAS  PubMed  Google Scholar 

  • Durie, M. (1998). Whaiora: Māori. Māori health development. Auckland: Oxford University Press.

    Google Scholar 

  • Glover, M. (2013). Analysing smoking using Te Whare Tapa Wha. In C. Banwell, S. Ulijaszek, J. Dixon (Eds.), When culture impacts health: Global lessons for effective health research (pp. 115–128). Netherland: Elsevier Publishers.

    Chapter  Google Scholar 

  • Glover, M., & Kira, A. (2011). Why Māori women continue to smoke while pregnant. The New Zealand Medical Journal, 124, 1339.

    Google Scholar 

  • Glover, M., Kira, A., Cowie, N., Wong, R., Stephen, J., & Marriner, K. (2010). The health, economic, cultural and social consequences of tobacco use in New Zealand among Māori. A report prepared for the Ministry of Health. Retrieved from Auckland.

  • Glover, M., Kira, A., Johnston, V., Walker, N., Thomas, D., Chang, A. B., Bullen, C., Segan, C. J., Brown, N. (2015). A systematic review of barriers and facilitators to participation in randomized controlled trials by Indigenous people from New Zealand, Australia, Canada and the United States. Global Health Promotion, 22(1), 21–31.

    Article  PubMed  Google Scholar 

  • Glover, M., Kira, A., & Smith, C. (2015). Enlisting “Aunties” to support indigenous pregnant women to stop smoking: Feasibility study results. Nicotine & Tobacco Research, 1–6. doi:10.1093/ntr/ntv146.

  • Haberg, S. E., Stigum, H., Nystad, W., & Nafstad, P. (2007). Effects of pre- and postnatal exposure to parental smoking on early childhood respiratory health. American Journal of Epidemiology, 166(6), 679–686.

    Article  PubMed  Google Scholar 

  • Heaman, M. I., & Chalmers, K. (2005). Prevalence and correlates of smoking during pregnancy: A comparison of aboriginal and non-aboriginal women in manitoba. Birth (Berkeley, Calif.), 32(4), 299–305.

    Article  Google Scholar 

  • Jaddoe, V. W. V., Verburg, B. O., De Ridder, M. A. J., Hofman, A., Mackenbach, J. P., Moll, H. A., … Witteman, J. C. M. (2007). Maternal smoking and fetal growth characteristics in different periods of pregnancy: The generation R study. American Journal of Epidemiology, 165(10), 1207–1215.

    Article  PubMed  Google Scholar 

  • Kim, S. Y., England, L., Dietz, P. M., Morrow, B., & Perham-Hester, K. A. (2010). Patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska native and white women in Alaska, 2000–2003. Maternal and Child Health Journal, 14(3), 365–372. doi:10.1007/s10995-009-0444-7.

    Article  CAS  PubMed  Google Scholar 

  • Lumley, J., Chamberlain, C., Dowswell, T., Oliver, S., Oakley, L., & Watson, L. (2009). Interventions for promoting smoking cessation during pregnancy. Cochrane Database Systematics Reviews 3. doi:10.1002/14651858.CD001055.pub3.

  • Mitchell, E., & Clements, M. (1997). Sudden infant death syndrome: An important and preventable cause of death in infancy. New Zealand Public Health Report, 4(9), 65–67.

    Google Scholar 

  • Morton, S. M. B., Atatoa Carr, P. E., Bandara, D. K., Grant, C. C., Ivory, V. C., Kingi, T. R., … Waldie, K. E. (2010). Growing Up in New Zealand: A longitudinal study of New Zealand children and their families. Report 1: Before we are born. Retrieved from Auckland.

  • Nelson, G., & Prilleltensky, I. (2005). Community psychology: In pursuit of liberation & well-being. Hampshire: Palgrave MacMillan Publishers.

    Book  Google Scholar 

  • Owen, L., & Penn, G. (1999). Smoking and pregnancy: A survey of knowledge attitudes and behaviour 1992–1999. Retrieved from London.

  • Pomerleau, C. S., Brouwer, R. J., & Jones, L. T. (2000). Weight concerns in women smokers during pregnancy and postpartum. Addictive Behaviors, 25, 759–767.

    Article  CAS  PubMed  Google Scholar 

  • Royal College of Physicians. (1992). Smoking and the young. A report of a working party of the Royal College of Physicians. Retrieved from London.

  • Salihu, H., Sharma, P., Getahun, D., Hedayatzadeh, M., Peters, S., Kirby, R., … Gaafer-Ahmed, H. (2008). Prenatal tobacco use and risk of stillbirth: A case-control and bidirectional case-crossover study. Nicotine and Tobacco Research, 10(1), 159–166.

    Article  PubMed  Google Scholar 

  • Smith, L. T. (1999). Decolonizing methodologies, research and indigenous peoples. New York: Zed Books.

    Google Scholar 

  • Stjernfeldt, M., Lindsten, J., Berglund, K., & Ludvigsson, J. (1986). Maternal smoking during pregnancy and risk of childhood cancer. Lancet, 1, 1350–1351.

    Article  CAS  PubMed  Google Scholar 

  • Thomas, D. R. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation, 27(2), 237–246. doi:10.1177/1098214005283748.

    Article  Google Scholar 

  • Toivonen, S., Heinonen, S., Anttila, M., Kosma, V. M., & Saarikoski, S. (2002). Reproductive risk factors, Doppler findings, and outcome of affected births in placental abruption: A population-based analysis. American Journal of Perinatology, 19, 451–456.

    Article  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services. (2008). Physical activity guidelines for Americans. Retrieved from https://health.gov/paguidelines/guidelines/.

  • U.S. Department of Health and Human Services. (2010). How tobacco smoke causes disease: What it means to you. Retrieved from National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

  • Ussher, M., Aveyard, P., Coleman, T., Straus, L., West, R., Marcus, B., … Manyonda, I. (2008). Physical activity as an aid to smoking cessation during pregnancy: Two feasibility studies. BMC Public Health, 8(1), 328.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ussher M, L. S., Aveyard P, Manyonda I, West R, Lewis B, Marcus B, Riaz M, Taylor A, Daley A, Coleman T. (2015). Physical activity for smoking cessation in pregnancy: Randomised controlled trial. BMJ, 350, h2145. doi:10.1136/bmj.h2145.

    Article  PubMed  PubMed Central  Google Scholar 

  • West, R. (2002). Smoking cessation and pregnancy. Fetal and Maternal Medicine Review, 13, 181–194.

    Article  Google Scholar 

  • Wideroe, M., Vik, T., Jacobsen, G., & Bakketeig, L. S. (2003). Does maternal smoking during pregnancy cause childhood overweight? Paediatric and Perinatal Epidemiology, 17(171–9).

  • Wright, T. E., & Tam, E. (2010). Disparate rates of persistent smoking and drug use during pregnancy of women of Hawaiian ancestry. Ethnicity & Disease, 20 (1 Suppl 1), S1-215-218.

    Google Scholar 

Download references

Acknowledgements

Enid Dorey, Toni Hunter-Laird for research assistance.

Author information

Authors and Affiliations

  1. National Institute for Health Innovation, School of Population Health, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand

    Vaughan Roberts, Natalie Walker & Ralph Maddison

  2. School of Public Health, College of Health, Massey University, Albany Highway, Albany, Auckland, 0632, New Zealand

    Marewa Glover

  3. Medicine, Obstetrics and Gynaecology, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand

    Lesley McCowan

  4. Population Health Research Institute, St. George’s University of London, London, UK

    Michael Ussher

  5. Toi Tangata, 115 Newton Road, Eden Terrace, Auckland, 1010, New Zealand

    Ihirangi Heke

  6. Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia

    Ralph Maddison

Authors
  1. Vaughan Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marewa Glover
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lesley McCowan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natalie Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Ussher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ihirangi Heke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ralph Maddison
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ralph Maddison.

Ethics declarations

Funding

This study was funded through the Health Research Council of New Zealand (HRC grant 12/683).

Appendix: Semi-Structured Focus Group/Key-Informant Interview Discussion Schedule

Appendix: Semi-Structured Focus Group/Key-Informant Interview Discussion Schedule

We are interested in your thoughts around an exercise programme for pregnant Māori women to help address smoking rates in this population group. We want to determine the most appropriate approach for delivery of such a programme.

What are your initial thoughts about the idea of a physical activity programme to help reduce smoking rates among pregnant Māori women?

Prompts: Is it a good idea? Why? Why not?

Do you have any concerns/fears around exercising whilst pregnant that would need to be addressed before participating in a physical activity programme? What might these be?

Do you do any exercise at the moment?

If we assume that it is safe and even beneficial for both mother and baby to exercise whilst pregnant, how would you like to see a physical programme like this delivered?

Prompts: What is the best way to deliver an exercise programme during pregnancy? Who should deliver it? What types of exercise would you consider to be good for Māori women during pregnancy? Where would you suggest that these exercises take place? Should they be individual or group-based programmes? Should they be supervised or unsupervised programmes?

If we were to conduct a study to look at the effectiveness of a physical activity programme in pregnant.

Māori women to reduce smoking rates:

What do you think of this idea?

Is this something you would consider?

What, if anything, would stop you from participating?

Is there anything else (apart from physical exercise, and stop smoking support) that you would like to see included in the programme?

Do you foresee any barriers to the acceptability of the intervention/participation in the intervention?

How would you suggest we overcome these barriers?

In order to maximise health outcomes we are hoping to recruit women in the early stages of pregnancy (the first 1–13 weeks). What would you suggest would be the best approach to recruit participants during the first 1–13 weeks of pregnancy?

Do you have any other comments?

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roberts, V., Glover, M., McCowan, L. et al. Exercise to Support Indigenous Pregnant Women to Stop Smoking: Acceptability to Māori. Matern Child Health J 21, 2040–2051 (2017). https://doi.org/10.1007/s10995-017-2303-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-017-2303-2

Keywords

Search

Navigation