KEY TAKEAWAY: Analyzes behavioural and pharmacological cessation trials tailored for pregnant Indigenous women, highlighting the balance of clinical safety and cultural contextualization.
Abstract
Objective
To synthesize evidence on smoking cessation interventions among pregnant Indigenous women.
Methods
We conducted a systematic search of databases from thier inception (MEDLINE, 1946; Embase, 1947; CENTRAL, 1991; APA PsycINFO, 1806; Informit Indigenous Collection, 1977; Bibliography of Indigenous Peoples in North America, 1900; and Global Health, 1973) to May 28, 2025. Eligible studies included trials targeting smoking or vaping cessation among pregnant Indigenous women. Interventions at the individual or community level were eligible, including education, counseling, pharmacotherapy, incentives, biomarker feedback, digital health, or community-based programs.
Results
Of 5534 studies screened, five studies involving 723 pregnant Indigenous women from Australia, New Zealand, and the United States met inclusion. Validated cessation rates were low, rarely exceeding 20% across interventions. Three studies reported improvements in quit attempts and quit-date setting. All interventions were feasible and acceptable, particularly those embedded within Indigenous health services. Facilitators included Indigenous leadership, provider training, and use of culturally relevant materials, whereas low recruitment (32%) and retention rates (<40%), staff turnover, and variable intervention fidelity were identified as barriers to intervention implementation.
Conclusions
Evidence suggests that although culturally adapted smoking cessation interventions are feasible, they have not consistently improved abstinence rates among pregnant Indigenous women, reflecting broader structural and contextual barriers.