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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

ID: 
31
Personal Details
First Name: 
Gillian
Last Name: 
Gould
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Maternal Indigenous smoking is a high priority – smoking in pregnancy is the major contributor to poor maternal and foetal outcomes. It contributes substantially to the Aboriginal health gap. 47% of pregnant Indigenous women smoke compared to 13% general population counterparts. Only 3-4% Indigenous women quit during pregnancy. One RCT in this population in Australia revealed small non-significant increases in quit rates. We need innovative, comprehensive strategies targeted across preconception, prenatal, postnatal and between pregnancies, from community-based, health provider and service levels. A TCR should encompass all these targets and levels of provision in one call. The research I am leading has extensively assessed factors that impair quitting from all angles: analysing data from focus groups and interviews with Aboriginal community members (pregnant women, men and women of reproductive age, family and Elders), health providers (GPs and Obstetricians) and services (47 including ACCHS and mainstream): the latter two nationally. Aboriginal pregnant women who smoke are not provided quality smoking cessation care, and need much more support from health providers and community levels. We do not know yet what will work. Promising interventions in mainstream populations have not been translated into the Indigenous context: a serious knowledge gap and unmet need.
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
A TRC on maternal Indigenous smoking would focus on priorities in the National Tobacco Strategy 2012-2018, National Drug Strategy, National Aboriginal and Torres Strait Islander Health Plan 2013–2023, National Child and Youth Strategic Framework for Health, and Closing the Gap Policy on smoking for Indigenous peoples, and NHRMC Road Map II action areas to establish research valuing Indigenous knowledge and addresses behavioural risk factors for chronic disease. Reducing smoking in Aboriginal people and pregnant women are strategic priorities for all State and Territory Health Departments for Aboriginal Health, Maternal and Child Health, and Tobacco including the NSW Tobacco and Aboriginal Tobacco Resistance and Control Framework (ATRAC). The early life of babies is of high concern, and smoking has a major impact on reduced birth weight, and has life-long consequences on learning and chronic disease such as diabetes, heart and respiratory disease and cancer.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
7000-9000 Indigenous babies are affected in utero by tobacco smoking every year. Babies exposed to smoking in utero are more likely to become smokers themselves. Tackling smoking in pregnancy women improves at least two people’s chances at a healthier life – mothers and babies, and has implications for the whole community. A whole of life course is becoming increasingly important for chronic disease prevention: one-sided approaches are less likely to be effective. Women need support from the community and health professionals, and approaches that span the whole reproductive spectrum.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
There is a high cost benefit from preventing intra-uterine exposure to tobacco smoke. The TCR would benefit Aboriginal women, babies and their family and community members through improved support for smoking cessation during pregnancy. Babies born to women who quit smoking have reduced complications and life-long benefits. Improvements to maternal and infant health through smoking cessation have a high benefit/cost ratio with better quality of life, reduced toxic exposure, reduced morbidity and mortality, and increased family income.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
I list my own papers, also see work of A/Prof Megan Passey. Contact me about research in progress with Indigenous mothers and health providers. • Gould, G. S., et al. (2016). Getting over the shock: Taking action on Indigenous maternal smoking. Australian Journal of Primary Health. Online 21/07/2016 • Gould, G. S., Bittoun, R., & Clarke, M. J. (2015). A Pragmatic Guide for Smoking Cessation Counselling and the Initiation of Nicotine Replacement Therapy for Pregnant Aboriginal and Torres Strait Islander Smokers. Journal of Smoking Cessation, 10(2), 96-105. • Gould, G. S. (2014). Exploring the barriers and enablers to smoking cessation in pregnant Aboriginal and Torres Strait Islander women with the behaviour change wheel. Australasian Epidemiologist, 21(2), 31-35. • Mendelsohn, C., Gould, G. S., & Oncken, C. (2014). Management of smoking in pregnant women. Australian Family Physician, 43(1), 46-51. • Gould, G. S. et al. (2013). "Nobody smokes in the house if there's a new baby in it": Aboriginal perspectives on tobacco smoking in pregnancy and in the household in regional NSW Australia. Women and Birth, 26(4), 246-253. • Gould, G. S., et al. (2013). Knowledge and views about maternal tobacco smoking and barriers for cessation in Aboriginal and Torres Strait Islanders: A systematic review and meta-ethnography. Nicotine and Tobacco Research, 15(5), 863-874.

Page reviewed: 30 August, 2018