Compiled by Joseph Magero.
On the 5th of July, 2019 we had a twitter Chat with Dr. Marewa Glover; Director of Research Excellence: Indigenous sovereignty and smoking. The focus of discussion was centered on tobacco harm reduction approaches during pregnancy. Below is a compilation of the chat.
Interviewer: We are glad you agreed to join the conversation today. Kindly introduce yourself, for those who may not be familiar with your work
Dr. Marewa Glover: Thank you for inviting me to chat. I’ve been working to reduce harms from smoking for 27 years in New Zealand. I’m particularly concerned that Maori indigenous people have x2+ smoking rates & not enough has been done to reduce inequity in rates. Smoking while pregnant is still way high at 45% in 18-24-year-old women.
Interviewer: How did you get into tobacco harm reduction?
Dr. Marewa Glover: In 1993 when working at Government Public Health Commission I learned smoking was biggest preventable killer; have stuck at trying to stop that ever since. We didn’t use a harm reduction approach, just promoted quit altogether. About 10 years ago I began lobbying for snus.
Interviewer: For those who may not be aware, what is tobacco harm reduction?
Dr. Marewa Glover: Harm reduction starts where person is at, respects them as a whole person coping with life; it’s different for each person. Working with people you look for ways to reduce risks harm will occur for example safer sex – use barrier methods contraception; driving? Wear seatbelts. Using harm reduction to reduce risks of tobacco smoking means encouraging people to switch to alternatives that carry less risk of harm. Sweden had snus, in USA people switched to chewing tobacco or snuff. Now there’s vaping-cigarettes, snus & heated tobacco products.
Interviewer: Tobacco smoking is one of the most significant reversible risk factors for the health of indigenous pregnant women and their babies? What are some of the dangers of smoking during pregnancy?
Dr. Marewa Glover: Pregnant women who smoke should be number one priority for tobacco control. There’s immediate risk of harm to baby in utero & health of mothers’ pregnancy. Because of higher smoking among Maori while pregnant we had higher Sudden Unexpected Deaths in Infancy, miscarriage, stillbirth, preterm…
Interviewer: There are over 300 Indigenous peoples in the world. Smoking prevalence is often higher among pregnant women in disadvantaged circumstances, for example, among Indigenous women. Why is this so?
Dr. Marewa Glover: There are over 370 million indigenous people in the world across 90 countries. Colonized NZ, Australia, USA, Canada indigenous all have disproportionately high smoking vs non-indigenous; Greenland Inuit 69%, but Scandinavian Saami have mostly switched to Safer alternatives. Many indigenous have been using tobacco for 100s-1000s of years e.g. Native American archaeological digs date smoking 3500yrs. Our smoking epidemics are older, longer & women often began at start. European women didn’t start until roaring 1920s/30s only 100ys ago. Big cultural difference.
Question: what cessation recommendations would you make for women who smoke during pregnancy? What quit programs should be targeted at them when they attend antenatal care?
Dr. Marewa Glover: Ideal = no drugs, caffeine, tobacco use, dope or alcohol while pregnant. If can’t do that then reduce risk as much as possible = stop most harmful drugs, alcohol, smoke; reduce consumption, use most effective nicotine replacement or snus or vaping i.e. Safer Alternatives Support them.
Pregnant mothers who smoke need support from healthcare & family 1) try quitting cold turkey 2) in few days reassess. If unable to quit discuss safer alternatives. What would she try? Which will work fastest to cut smoke consumption? Which will she likely stick at? Get nicotine level right.
Interviewer: Would you then recommend safer alternatives such as vapes, snus, HNB for pregnant women who are unable to quit smoking?
Dr. Marewa Glover: Which Safer Alternatives a pregnant mum can access, afford & find acceptable will vary by woman, region & country: snus estimated 2 b 98% safer vs smoking vaping 95% safer HnB 85% safer. Work with her where she’s at with her circumstances, and finances. Get partner/family 2 support & quit too.
Interviewer: Finally, what recommendations would you make for future interventions and policy changes in regard to accessibility of these alternatives to pregnant smokers?
Dr. Marewa Glover: Pregnant women who smoke should be priority focus in tobacco control & healthcare; incentive programs (vouchers/$) work, Vape2Save looks promising, Safer alternatives e.g. snus vaping already being used by mums and systematic review of evidence suggests these are lower risk vs smoking.
Please check out my Award-winning video series supporting pregnant mums with all the changes they need to make for the health of their pregnancy & baby “When one of us is pregnant, all of us are pregnant“.